SF4728 (Legislative Session 94 (2025-2026))
Nursing facility level of care modification for purposes of certain home and community-based waiver services
AI Generated Summary
Purpose
Clarify how a person’s nursing facility level of care will affect payment for certain home- and community-based waiver services, by changing the way cases are classified for payment and which payment model is used based on when the assessment date occurs.
Main provisions
- The bill adds new definitions to the nursing facility level of care determination process. These definitions explain terms used to determine payment for long-term care and related waiver services.
- It creates a split in the payment method based on the Assessment Reference Date (ARD):
- For ARD on or after October 1, 2025, payments use the Patient Driven Payment Model (PDPM), a case-mix reimbursement system.
- For ARD on or before September 30, 2025, payments use the traditional Resource Utilization Group (RUG) system.
- The PDPM and RUG classifications apply to payments for:
- Nursing facility services under state medical assistance (MA) rules (chapter 256R)
- Elderly waiver services under chapter 256S
- CADI and BI waiver services under section 256B.49
- State payment of alternative care services under section 256B.0913
- The bill defines core terms used in the funding and assessment process, such as MDS (Minimum Data Set), ARD, ADL (Activities of Daily Living), and what constitutes a “nursing facility level of care determination.”
Significant changes to existing law
- Shifts the payment model from RUG (existing for ARD on/before Sept. 30, 2025) to PDPM (new for ARD on/after Oct. 1, 2025) for the specified long-term care and HCBS waiver services.
- Explicitly ties the nursing facility level of care determination to these payments, with the ARD date acting as the cutoff between the two reimbursement systems.
- Introduces standardized definitions (ARD, MDS, ADL, case mix index, index maximization, PDPM, RUG) to support the updated payment framework and ensure consistent classification for eligibility and funding.
How this affects program operations
- Agencies and facilities will need to prepare for PDPM-based payments starting October 1, 2025, while continuing to use RUG-based payments for ARD dates prior to that.
- The changes affect how case mix is calculated and interpreted for the broader spectrum of long-term care funding tied to waivers and alternative care programs.
Definitions added or clarified (key terms)
- Assessment Reference Date (ARD)
- Case mix index
- Index maximization
- Minimum Data Set (MDS)
- Representative
- Activities of Daily Living (ADL)
- Nursing facility level of care determination
- Patient Driven Payment Model (PDPM)
- Resource Utilization Group (RUG)
Relevant Terms ARD MDS ADL Nursing facility level of care determination PDPM RUG Case mix index Index maximization Elderly waiver (256S) CADI waiver (256B.49) BI waiver (256B.49) 256R (nursing facility MA payments) 256S (elderly waiver) 256B.49 (CADI/BI waivers) 256B.0913 (state payment of alternative care)
Bill text versions
- Introduction PDF PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| March 23, 2026 | Senate | Action | Introduction and first reading | ||
| March 23, 2026 | Senate | Action | Referred to | Human Services |
Citations
[
{
"analysis": {
"added": [
"Patient Driven Payment Model (PDPM) definition.",
"Definitions for ARD, Case Mix Index, Index Maximization, Minimum Data Set (MDS), Activities of Daily Living (ADLs), and related terms as used in the section."
],
"removed": [],
"summary": "Amends Minnesota Statutes to redefine terms and definitions used for nursing facility level of care determinations, including how data elements (MDS, ARD, ADLs, RUG/PDPM) are used to determine eligibility and payment under various long-term care programs.",
"modified": [
"Subd. 2 updated to formalize the definitions that underpin nursing facility level of care determinations and their connection to multiple funding/waiver programs (MA, LTP, etc.).",
"Incorporates cross-references to subsequent subdivisions (e.g., subdivision 11 and 11a) for level-of-care determinations."
]
},
"citation": "144.0724",
"subdivision": "subd.2"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References subdivision 11 as the established mechanism for nursing facility level of care determinations used for purposes of medical assistance payments and related long-term care services.",
"modified": [
"Subdivision 11 is invoked as a controlling provision for how LCO determinations affect MA payments and long-term care service eligibility."
]
},
"citation": "144.0724",
"subdivision": "subd.11"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References subdivision 11a as an alternative or additional pathway for level-of-care determinations within the same framework.",
"modified": [
"Subdivision 11a is recognized in conjunction with subdivision 11 to govern LCO determinations used for MA payments and waiver services."
]
},
"citation": "144.0724",
"subdivision": "subd.11a"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cites Minnesota Statutes 256B.0911, subdivision 26 to support or define aspects of state payment for care or waivers tied to the LCO framework.",
"modified": [
"Subdivision 26 is referenced to align LCO-related payments with the state’s framework for alternative care and waiver funding under 256B."
]
},
"citation": "256B.0911",
"subdivision": "subd.26"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References chapter 256R (nursing facility services) as part of the long-term care payment and service framework.",
"modified": [
"Cross-reference to chapter 256R for the provision of nursing facility services within the LCO and MA payment context."
]
},
"citation": "256R",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "References chapter 256S (elderly waiver services) in the context of LCO determinations and long-term care funding.",
"modified": [
"Cross-reference to chapter 256S for waiver services incorporated into the LCO framework."
]
},
"citation": "256S",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cites section 256B.49 (CADI and BI waiver services) as part of the waiver services considered in determining LCO-related eligibility and payments.",
"modified": [
"Cross-reference to 256B.49 for waiver services assessed under LCO determinations."
]
},
"citation": "256B.49",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cites section 256B.0913 (state payment of alternative care services) within the LCO and waiver funding context.",
"modified": [
"Cross-reference to 256B.0913 to address state payment for alternative care services under the LCO framework."
]
},
"citation": "256B.0913",
"subdivision": ""
}
]Progress through the legislative process
In Committee