Modification of Nursing Facility Level of Care (NF LOC) criteria

NF LOC and ECS implemented January 1, 2015

The Department of Human Services implemented the revised Nursing Facility Level of Care (NF LOC) criteria and the Essential Community Supports (ECS) program effective January 1, 2015. These revised criteria are found in MN Statutes 144.0724, Subd. 11.

NF LOC criteria

In 2009, the Minnesota Legislature passed legislation that changes nursing facility level of care (NF LOC) criteria for public payment of long-term care. This change affects the most independent people who would receive publicly-funded nursing facility services or publicly-funded long-term care services in the community through programs such as Elderly Waiver (EW), Alternative Care (AC), and Community Access for Disability Inclusion (CADI). The legislation also provides an alternative for some individuals 65 years or older whose eligibility for Medical Assistance or Alternative Care is affected.

Why was the NF LOC criteria modified?

This change is important to:

  • • Provide more consistent access to services
  • • Address Minnesota’s aging demographics and manage growth in public spending for long term care
  • • Support service sustainability
  • • Improve the ability of lead agencies to assess individuals, monitor programs, evaluate outcomes and assess the impact of public spending.
  • What services and programs are affected?

    The NF LOC criteria apply to:

  • • Medical Assistance (MA) payment for nursing home services
  • • Public payment for home and community-based service programs that provide alternatives to nursing home services. These programs include the state-funded Alternative Care (AC) program for people age 65 and older, and the MA-funded Elderly Waiver (EW), Community Access for Disability Inclusion (CADI), and Brain Injury – NF (BI-NF) programs.
  • What are the NF LOC criteria?

    To meet the criteria, an individual must be assessed for at least one of the following:

    1. A high ADL need:

  • • Need for assistance in four or more ADLS; or
  • • Need for assistance that cannot be scheduled in toileting, transferring, or positioning;
    OR
  • 2. An ongoing clinical need

  • • Need for clinical monitoring at least once a day
    OR
  • 3. A cognitive impairment or behavioral needs as indicated by significant difficulty with:

  • • Memory; or
  • • Using information; or
  • • Daily decision-making; or
  • • Behavior needs that require at least occasional intervention
    OR
  • 4. At institutional risk

  • • A qualifying NF admission of at least 90 days; or
  • • The person lives alone, or would live alone or be homeless without their housing type AND at least one of the following risk factors is also present, as determined by a face-to-face Long Term Care Consultation assessment as specified in MN Statute, section 256B.0911, subdivisions 3a, 3b or 4d:
  • 1) The person has experienced a fall resulting in a fracture, or
    2) The person has been determined to be at risk of maltreatment or neglect, including self-neglect, or
    3) The person has a sensory impairment that substantially impacts functional ability and maintenance of a community residence

    When will this change be implemented?

    The Department of Human Services implemented the revised Nursing Facility Level of Care (NF LOC) criteria and the Essential Community Supports (ECS) program effective January 1, 2015. These revised criteria are found in MN Statutes 144.0724, Subd. 11.

    What is the Essential Community Supports program?

    The Essential Community Supports (ECS) program provides alternatives for people 65 years or older whose eligibility for Medical Assistance or Alternative Care is affected by the change in NF LOC.

    ECS also provides alternative services for people who were on a waiver program as of January 1, 2015 and subsequently lose eligibility for MA payment of waiver services due to not meeting the NF LOC criteria at their next assessment on or after January 1, 2015.

    Resources

    Forms
    DHS-7028 Nursing facility Level of Care Criteria (Effective January 1, 2015 for individuals age 21 and older)
    DHS-3361 Nursing Facility Level of Care Criteria (for individuals under 21 years old)

    Bulletins
    Bulletin 14-25-09
    - NF LOC Criteria Changing January 1, 2015 - Update and Legislative Changes
    Bulletin 14-25-10
    - NF LOC Criteria Changing January 1, 2015 - Nursing Facilities & Residents
    Bulletin 14-25-12
    - Nursing Facility Level of Care Criteria Changing January 1, 2015 - Home and Community-Based Programs
    Bulletin 14.25.13
    - Essential Community Supports Program Available January 1,2015
    Bulletin 15-25-03
    - Lead Agency Implementation of NF LOC Changes: Additional Operational Information

    NF LOC Trainings
    Nursing Facility Level of Care training
    occurred extensively in 2014. On this page you find links to archived sessions and previous trainings.

    Contact
    E-mail an questions or comments to dhs.nfloc@state.mn.us


    Rate/Report this page   Report/Rate this page

    Related Pages

    Related Links