Eligible Members

LTCFs provide services to elderly people, people with physical disabilities, and people with developmental disabilities and related conditions. These individuals have been screened and determined to need a nursing facility level of care.

PrimeWest Health Minnesota Senior Care Plus (MSC+), Special Needs BasicCare (SNBC), Prime Health Complete (HMO SNP), and PrimeWest Senior Health Complete (HMO SNP) eligible members must reside in a certified bed that matches their certified level of care.

Nursing facility level of care can be determined through a face-to-face assessment conducted by a lead agency (county, tribe, or managed care organization) with the authority to determine eligibility for the programs listed as specified under Minnesota Stat. sec. 256B.0911 governing Long Term Care Consultation Services (LTCCS). Nursing facility level of care is also determined through preadmission screening as described in Minnesota Stat. sec. 256.975. The Nursing Facility Level of Care Criteria document can also be used to assist in determining eligibility for long-term care.

PrimeWest Health will cover the cost of care for a member who resides in a certified nursing facility, certified BCH, or licensed ICF/DD if all of the following requirements are met:

Certified Nursing Facility and Certified Boarding Care Home (BCH)

1. The care is ordered by a physician
2. The care is provided in compliance with State and Federal regulations
3. The care provided in a nursing facility or BCH is required because of physical or mental limitations determined through the Preadmission Screening (PAS) process or Long-Term Care Consultation (LTCC) process completed by the county prior to admission to the facility, with certain exceptions defined below.

Swing Bed Hospital

Specifications are in the Swing Bed section.