42 C.F.R. 440.10, 42 C.F.R. 440.150, 42 C.F.R. 441.301, 42 U.S.C. 1396r (also known as §1919 of the Social Security Act), Minn. Stat. §144.0724, Minn. Stat. §256B.434, Minn. Stat. §256B.49

Institutional level of care (LOC): The minimum amount of specified assistance a person needs to be eligible to receive services in an institutional setting. This determination is based on Minnesota's agreement with the federal Centers for Medicare & Medicaid Services (CMS).

This page applies to:

1. Alternative Care (AC) program.

2. The following home and community-based services (HCBS) waivers:

AC and HCBS waivers allow people with institutional LOC distinctions to be supported in the community in the least restrictive setting of their choice instead of institutions.

There are four institutional LOC distinctions:

Each LOC distinction has criteria associated with the services provided in a particular institution type. The LOC determination ensures the person receives the most appropriate supports and services to address their specialized needs.

When a person is seeking AC or HCBS waiver services, the lead agency is responsible to determine their institutional LOC through a MnCHOICES assessment. For more information, refer to CBSM – MnCHOICES assessment process.

For NF LOC, the person must meet one of the following five categories of need:

1. Meets criteria related to cognitive or behavioral needs (e.g., significant difficulty with memory, using information, daily decision-making or behavioral needs that require intervention).

2. Needs activities of daily living (ADLs) support in at least four of the eight categories (i.e., eating, dressing, grooming, bathing, toileting, positioning, transferring and mobility).

3. Needs critical ADLs support in one of the following categories:

4. Needs clinical monitoring at least once per day.

5. Meets criteria for living arrangement and risk as described in the section below.

For specific information about the five categories of need, refer to CBSM – Resource: NF LOC criteria guide.

Living arrangement and risk criteria

To meet the fifth category of need for NF LOC (i.e., living arrangement and risk), the person must meet both of the following criteria:

1. Has one of the following planned living arrangements:

2. Meets one of the following risk criteria:

Programs that require this LOC

The following programs require an NF LOC determination:

Additional BI-NF criteria

To meet BI-NF LOC, the person must meet the NF LOC criteria and need the types of specialized services available in NFs that support people with brain injuries and significant cognitive or behavioral needs.

For ICF/DD LOC, the person must meet all the following criteria:

For more information, refer to:

Program that requires this LOC

The DD Waiver requires an ICF/DD LOC determination.

For hospital LOC, the person must meet all the following criteria:

Lead agencies must obtain documentation annually from a medical provider that confirms the person's treatment, monitoring or intervention needs using MnCHOICES Primary Medical Provider’s Documentation of Medical Monitoring and Treatment Needs, DHS-7096.

Note: For LOC purposes, "hospital" does not refer to hospitalization for in-patient behavioral health services (e.g., community behavioral health hospitals [CBHHs], institutions for mental diseases [IMDs], regional treatment centers [RTCs]), per 42 C.F.R. 440.10.

Program that requires this LOC

The CAC Waiver requires a hospital LOC determination.

For NB LOC, the person must meet NF LOC criteria and require all the following:

Program that requires this LOC

The BI-NB Waiver requires an NB LOC determination.