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

Level of care (LOC): A particular amount of care and services required to meet a person's needs.

There are four level of care distinctions:

Each level of care distinction has criteria associated with the services provided in a particular institution type. Needing a particular level of care is an eligibility requirement for:

The lead agency determines level of care during an assessment process for people who request home and community-based services under Medical Assistance (MA).

The lead agency may need to complete an assessment for a person who has been admitted to a nursing facility and requires a final determination of NF level of care. For more information, refer to CBSM – Preadmission screening and OBRA.

For ICF/DD level of care, the person must meet all of the following criteria:

For more information, refer to:

HCBS waiver that requires this level of care

The Developmental Disabilities (DD) Waiver requires a person to need an ICF/DD level of care.

For hospital level of care, the person must meet all of 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 level of care 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.

HCBS waiver that requires this level of care

The Community Alternative Care (CAC) Waiver requires a person to need a hospital level of care.

For nursing facility (NF) level of care, a person must meet one of the following five categories of need:

1. Does/would live alone or be homeless without current housing type and meets one of the following:

2. Has a dependency in four or more activities of daily living (ADLs).

3. Has significant difficulty with memory, using information, daily decision-making or behavioral needs that require intervention.

4. Needs the assistance of another person or constant supervision to complete toileting, transferring or positioning, and this assistance cannot be scheduled.

5. Needs formal clinical monitoring at least once a day.

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

HCBS waivers/program that require this level of care

The following require a person to need an NF level of care:

Additional level of care criteria for the BI-NF Waiver

In addition to the NF level of care criteria listed above, the BI-NF Waiver requires a person to need the level of care and types of specialized services available in nursing facilities that support people with brain injuries and significant cognitive/behavioral needs.

For neurobehavioral hospital (NB) level of care, the person must meet NF level of care criteria and require all of the following:

HCBS waiver that requires this level of care

The Brain Injury Neurobehavioral (BI-NB) Waiver requires a person to have an NB level of care.