Subdivision 1. Requests for elderly waiver monthly conversion budget caps. A participant who is a nursing facility resident when requesting an eligibility determination for elderly waiver services may request an elderly waiver monthly conversion budget cap for the cost of elderly waiver services.
Subd. 2. Eligibility for elderly waiver monthly conversion budget caps. Only a participant discharged from a nursing facility after a minimum 30-day stay is eligible under this section for an elderly waiver monthly conversion budget cap.
Subd. 3. Calculation of monthly conversion budget cap without consumer-directed community supports. (a) The elderly waiver monthly conversion budget cap for the cost of elderly waiver services without consumer-directed community supports must be based on the nursing facility case mix adjusted total payment rate of the nursing facility where the elderly waiver applicant currently resides for the applicant's case mix classification as determined according to section 256R.17.
(b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver services without consumer-directed community supports shall be calculated by multiplying the applicable nursing facility case mix adjusted total payment rate by 365, dividing by 12, and subtracting the participant's maintenance needs allowance.
(c) A participant's initially approved monthly conversion budget cap for elderly waiver services without consumer-directed community supports shall be adjusted at least annually as described in section 256S.18, subdivision 5.
Subd. 4. Calculation of monthly conversion budget cap with consumer-directed community supports. For the elderly waiver monthly conversion budget cap for the cost of elderly waiver services with consumer-directed community supports, the nursing facility case mix adjusted total payment rate used under subdivision 3 to calculate the monthly conversion budget cap for elderly waiver services without consumer-directed community supports must be reduced by a percentage equal to the percentage difference between the consumer-directed community supports budget limit that would be assigned according to the elderly waiver plan and the corresponding monthly case mix budget cap under this chapter, but not to exceed 50 percent.
2019 c 54 art 1 s 19; 1Sp2020 c 2 art 2 s 32
Structure Minnesota Statutes
Chapters 245 - 267 — Public Welfare And Related Activities
Chapter 256S — Medical Assistance Elderly Waiver
Section 256S.02 — Definitions.
Section 256S.03 — Administration By Tribes.
Section 256S.04 — Limits Of Elderly Waiver Cases.
Section 256S.05 — Eligibility.
Section 256S.06 — Assessments And Reassessments.
Section 256S.07 — Case Management Administration.
Section 256S.08 — Case Management Provider Qualifications And Standards.
Section 256S.09 — Case Management Activities.
Section 256S.10 — Support Plans.
Section 256S.11 — Approval Required For Certain State Plan Home Care Services.
Section 256S.12 — Adult Day Services.
Section 256S.13 — Individual Community Living Supports.
Section 256S.14 — Termination Of Elderly Waiver Services.
Section 256S.15 — Establishment Of Elderly Waiver Service Rates And Service Rate Limits.
Section 256S.16 — Authorization Of Elderly Waiver Services And Service Rates.
Section 256S.17 — Costs Excluded From Elderly Waiver Service Rates.
Section 256S.18 — Monthly Case Mix Budget Caps; Generally.
Section 256S.19 — Monthly Case Mix Budget Caps; Nursing Facility Residents.
Section 256S.20 — Customized Living Services; Policy.
Section 256S.201 — Customized Living Services; Rates.
Section 256S.202 — Customized Living Services; Rate Limits.
Section 256S.203 — Customized Living Services; Managed Care Rates.
Section 256S.204 — Alternative Rate System For 24-hour Customized Living Services.
Section 256S.205 — Customized Living Services; Disproportionate Share Rate Adjustments.
Section 256S.21 — Rate Setting; Application.
Section 256S.2101 — Rate Setting; Phase-in.
Section 256S.211 — Rate Setting; Rate Establishment.
Section 256S.212 — Rate Setting; Base Wage Index.
Section 256S.213 — Rate Setting; Factors.