Nursing facility scenarios

Page posted: 6/27/19		Page reviewed: 10/17/23	Page updated: 3/25/26
Overview	This page contains sequencing charts for: 1. Nursing facility (NF) to Developmental Disabilities (DD) diversion/conversion. 2. NF to DD diversion/conversion using an eligibility update when waiver start date is unknown (for assessments before July 1, 2025). 3. NF to DD diversion/conversion using an eligibility update when waiver start date is known (for assessments before July 1, 2025). 4. NF to community intermediate care facility for persons with developmental disabilities (ICF/DD). 5. NF to semi-independent living services (SILS). 6. NF to community – In-person assessment was completed and the person chooses BI, CAC, CADI or no support. 7. NF to DD diversion/conversion for a person who experiences an NF stay fewer than 30 days (historical scenario). 8. NF to DD diversion/conversion for a person who experiences an NF stay fewer than 121 days. 9. NF to DD diversion/conversion using an initial assessment review (IAR) when waiver start date is unknown (for assessments on or after July 1, 2025). 10. NF to DD diversion/conversion using an IAR when waiver start date is known (for assessments on or after July 1, 2025). 11. NF to DD conversion/diversion within 60 days of the MnCHOICES assessment. Note MMIS automatically routes some documents to DHS to review. Lead agencies are no longer required to route documents manually to DHS.
Additional resources	DD Screening Document Codebook – Scenarios CBSM – Eligibility update for home and community-based services CBSM – SILS DD Waiver Waiting List Category Determination Tool, DHS-7209 (PDF) CBSM – DD Waiver waiting list guide

1. Scenario: NF to DD diversion/conversion

County/tribal nation-entered fields	1st sequence
(23) Action date	In-person assessment date
(24) Action type	01
(39) Level of care	01
(41) Current services	01, waiver service codes, residential code, other
(42) Planned services	01, waiver service codes, residential code, other
(44) Waiver need index	004
(46) Final action planned	01 or 04
(47a) Assessment result	04 – Waiver in
(47b) Exit reason	N/A
(48) Effective date	Waiver start date
(49) Current Medical Assistance (MA) program	01 or 02
NF begin and through dates	Delete dates previously entered
Time-limited field	N
Payment authorized	01
Case manager comments	Discharge information

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2. Scenario: NF to DD diversion/conversion using an eligibility update when waiver start date is unknown (for assessments before July 1, 2025)

Note: If the person will access the DD Waiver within 60 days of the first assessment (i.e., action type 01), the lead agency should use the 1st and 3rd sequences of this scenario to open to the DD Waiver. Refer also to 11. Scenario: NF to DD conversion/diversion within 60 days of the MnCHOICES assessment.

County/tribal nation-entered fields	1st sequence	2nd sequence – Completed within 60-90 days of the in-person assessment	3rd sequence – Completed within 60 days of the eligibility update
(23) Action date	In-person assessment date	Assessment date	Waiver in date
(24) Action type	01	12	03
(39) Level of care	01 or 02	01	01
(41) Current services	19, 30, other	19, 30, other	01, waiver service codes, residential code, other
(42) Planned services	01, waiver service codes, residential code, other	01, waiver service codes, residential code, other	01, waiver service codes, residential code, other
(44) Waiver need index	001, 006	001, 006	004
(46) Final action planned	01 or 04	01 or 04	01 or 04
(47a) Assessment result	16 – Facility stay	16 – Facility stay	04 – Waiver in
(47b) Exit reason	N/A	N/A	N/A
(48) Effective date	In-person assessment date	Telephone assessment date	Waiver in date
(49) Current MA program	05	05	01 or 02
NF begin and through dates	Leave dates previously entered	Leave dates previously entered	Delete dates previously entered
Time-limited field	Y	Y	N
Payment authorized	04	04	01
Case manager comments	Comments as needed	Comments as needed	Discharge information

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3. Scenario: NF to DD diversion/conversion using an eligibility update when waiver start date is known (for assessments before July 1, 2025)

County/tribal nation-entered fields	1st sequence	2nd sequence
(23) Action date	In-person assessment date	Assessment date
(24) Action type	01	12
(39) Level of care	01 or 02	01
(41) Current services	19, 30, other	01, waiver service codes, residential code, other
(42) Planned services	Waiver service codes, residential code, other	01, waiver service codes, residential code, other
(44) Waiver need index	001, 006	004
(46) Final action planned	01 or 04	01 or 04
(47a) Assessment result	16 – Facility stay	04 – Waiver in date
(47b) Exit reason	N/A	N/A
(48) Effective date	In-person assessment date	Waiver in date
(49) Current MA program	05	01 or 02
NF begin and through dates	Leave dates previously entered	Delete dates previously entered
Time-limited field	Y	N
Payment authorized	04	01
Case manager comments	Comments as needed	Discharge information

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4. Scenario: NF to community ICF/DD

County/tribal nation-entered fields	1st sequence
(23) Action date	In-person assessment date
(24) Action type	01
(39) Level of care	01
(41) Current services	19, other
(42) Planned services	19, 28, other
(44) Waiver need index	Use DHS-7209 (PDF) to determine
(46) Final action planned	07
(47a) Assessment result	16 – Facility stay
(47b) Exit reason	N/A
(48) Effective date	ICF/DD admission date
(49) Current MA program	04
NF begin and through dates	Delete dates previously entered
Time-limited field	N
Payment authorized	01
Case manager comments	Discharge information

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5. Scenario: NF to SILS

County/tribal nation-entered fields	1st sequence
(23) Action date	In-person assessment date
(24) Action type	01
(39) Level of care	03
(41) Current services	19, 24, other
(42) Planned services	19, 24, other
(44) Waiver need index	005
(46) Final action planned	05
(47a) Assessment result	14 – Community with services – Not DD Waiver
(47b) Exit reason	N/A
(48) Effective date	SILS start date
(49) Current MA program	00
NF begin and through dates	Delete dates previously entered
Time-limited field	N
Payment authorized	05
Case manager comments	Discharge information

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6. Scenario: NF to community – In-person assessment was completed and the person chooses BI, CAC, CADI or no support

County/tribal nation-entered fields	1st sequence
(23) Action date	In-person assessment date
(24) Action type	01
(39) Level of care	As determined
(41) Current services	19 (as appropriate), other
(42) Planned services	19 (as appropriate), residential code, other
(44) Waiver need index	Use DHS-7209 (PDF) to determine
(46) Final action planned	Corresponds with field 42 planned services
(47a) Assessment result	Either: · 12 – Community without services · 14 – Community with services – Not DD Waiver
(47b) Exit reason	N/A
(48) Effective date	NF discharge date
(49) Current MA program	00 or 06
NF begin and through dates	Delete dates previously entered
Time-limited field	N
Payment authorized	06 or 07
Case manager comments	Discharge information

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7. Scenario: NF to DD diversion/conversion for a person who experiences an NF stay fewer than 30 days (historical scenario)

Effective May 1, 2022, this scenario is for historical purposes only.

Note: Lead agencies could only use this scenario if the person was previously on the DD Waiver and needed to return to the DD Waiver within 29 days of the documented waiver out effective date.

County/tribal nation-entered fields	1st sequence
(23) Action date	Waiver in date
(24) Action type	03
(39) Level of care	01
(41) Current services	01, residential code, other
(42) Planned services	01, residential code, other
(46) Final action planned	Corresponds with field 42 planned services
(47a) Assessment result	04 – Waiver in
(47b) Exit reason	N/A
(48) Effective date	Waiver start date
(49) Current MA program	01 or 02 (must be the program from which the person exited before the NF stay)
NF begin and through dates	Delete dates previously entered
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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8. Scenario: NF to DD diversion/conversion for a person who experiences an NF stay fewer than 121 days

Note: Lead agencies can only use this scenario if the person was previously on the DD Waiver and needs to return to the DD Waiver within 121 days of the documented waiver out effective date.

This scenario is only necessary when a person is younger than age 65 refuses the MnCHOICES assessment within 80 days of admission or exits the NF before the lead agency completes the assessment. Lead agencies should use the MnCHOICES assessment and subsequent eligibility update to open the person to the DD Waiver. For people age 65 and older, lead agencies should use this scenario if the person has a waiver span to which they can return. For more information, refer to CBSM – Temporary exits and restarts: MMIS actions.

County/tribal nation-entered fields	1st sequence
(23) Action date	Waiver in date
(24) Action type	03
(39) Level of care	01
(41) Current services	01, residential code, other
(42) Planned services	01, residential code, other
(46) Final action planned	Corresponds with field 42 planned services
(47a) Assessment result	18 – Restart waiver
(47b) Exit reason	N/A
(48) Effective date	Waiver start date
(49) Current MA program	01 or 02 (must be the program from which the person exited before the NF stay)
NF begin and through dates	Delete dates previously entered
Time-limited payment	N
Payment authorized	01
Case manager comments	Comments as needed

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9. Scenario: NF to DD diversion/conversion using an IAR when waiver start date is unknown (for assessments on or after July 1, 2025)

Note: If the person will access the DD Waiver within 60 days of the first assessment (i.e., action type 01), the lead agency should use the 1st and 3rd sequences of this scenario to open to the DD Waiver.

County/tribal nation-entered fields	1st sequence	2nd sequence	3rd sequence – Completed within 60 days of the IAR
(23) Action date	In-person assessment date	Assessment date	Waiver in date
(24) Action type	01	14	03
(39) Level of care	01 or 02	01	01
(41) Current services	19, 30, other	19, 30, other	01, waiver service codes, residential code, other
(42) Planned services	01, waiver service codes, residential code, other	01, waiver service codes, residential code, other	01, waiver service codes, residential code, other
(44) Waiver need index	001, 006	001, 006	004
(46) Final action planned	01 or 04	01 or 04	01 or 04
(47a) Assessment result	16 – Facility stay	16 – Facility stay	04 – Waiver in
(47b) Exit reason	N/A	N/A	N/A
(48) Effective date	In-person assessment date	Telephone assessment date	Waiver in date
(49) Current MA program	05	05	01 or 02
NF begin and through dates	Leave dates previously entered	Leave dates previously entered	Delete dates previously entered
Time-limited field	Y	Y	N
Payment authorized	04	04	01
Case manager comments	Comments as needed	Comments as needed	Discharge information

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10. Scenario: NF to DD diversion/conversion using an IAR when waiver start date is known (for assessments on or after July 1, 2025)

County/tribal nation-entered fields	1st sequence	2nd sequence
(23) Action date	In-person assessment date	Assessment date
(24) Action type	01	14
(39) Level of care	01 or 02	01
(41) Current services	19, 30, other	01, waiver service codes, residential code, other
(42) Planned services	Waiver service codes, residential code, other	01, waiver service codes, residential code, other
(44) Waiver need index	001, 006	004
(46) Final action planned	01 or 04	01 or 04
(47a) Assessment result	16 – Facility stay	04 – Waiver in date
(47b) Exit reason	N/A	N/A
(48) Effective date	In-person assessment date	Waiver in date
(49) Current MA program	05	01 or 02
NF begin and through dates	Leave dates previously entered	Delete dates previously entered
Time-limited field	Y	N
Payment authorized	04	01
Case manager comments	Comments as needed	Discharge information

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11. Scenario: NF to DD conversion/diversion within 60 days of the MnCHOICES assessment

Note: Counties/tribal nations must conduct an assessment within 80 days of admission for people younger than age 64. Counties/tribal nations use this scenario to open a person to the waiver within 60 days of this assessment type. If the person does not discharge from the NF within 60 days, follow the IAR scenarios above.

County/tribal nation-entered fields	1st sequence	2nd sequence
(23) Action date	In-person assessment date	Discharge date
(24) Action type	01	03
(39) Level of care	01 or 02	01
(41) Current services	19, 30, other	01, waiver service codes, residential code, other
(42) Planned services	01, Waiver service codes, residential code, other	01, waiver service codes, residential code, other
(44) Waiver need index	001, 006	004
(46) Final action planned	01 or 04	01 or 04
(47a) Assessment result	16 – Facility stay	04 – Waiver in date
(47b) Exit reason	N/A	N/A
(48) Effective date	In-person assessment date	Waiver in date
(49) Current MA program	05	01 or 02
NF begin and through dates	Leave dates previously entered	Delete dates previously entered
Time-limited field	Y	N
Payment authorized	04	01
Case manager comments	Comments as needed	Discharge information