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MDS 3.0 Resident Assessment Instrument

by Published On: Mar 24, 2011Updated On: Mar 29, 2012

MDS 3.0 RAI Manual

The purpose of this manual is to offer guidance on how to code and use the Minimum Data Set Version 3.0 (MDS 3.0) correctly and effectively to help provide appropriate care. The Resident Assessment Instrument (RAI) manual (last updated Aug. 31, 2011) provides item-by-item coding instructions for all required sections and items in the comprehensive MDS Version 3.0 item. 

Chapter 6 of the manual provides informtion on how the RUGs grouper calculates the appropriate RUGs-IV classiciation based on the data from an MDS 3.0 assessment, including determinations of ADL scores and total rehabilitation therapy minutes.

For the complete RAI manual, download and print a free copy of the latest version of the manual from CMS. Also available is a list of all the changes to the MDS 3.0 RAI Manual as of Sept. 14, 2010 and the latest changes from the May 2011 update. 2011 Downtime Dates/Times: QIES has a complete schedule for downtime dates and times for 2011.

Notices and Updates

March 29, 2012: CMS published the Clarifications to the March 2012 National Provider Conference Presentation, which provides clarification for certain SNF PPS payment and assessment completion policies that will all be in effect April 1, 2012.

March 22, 2012CMS presentations from the March 2012 MDS 3.0 National Conference held in St. Louis, MO, are now available.

Jan. 23, 2012MDS 3.0 V1.08 of the RAI Manual and Item Set that will be effective April 1, 2012, is now available online. Also available are: 

Nov. 3, 2011: CMS has just released a new MDS 3.0 clarifications document based on the Nov. 3, 2011, National Provider Call Follow-Up and Clarifications. Clarification include use of the term “day of discharge,” early assessment penalty policy, relationship between the COT and Day of Discharge, beginning of COT observation period, completion of interview items on COT OMRA, when a COT evaluation should be completed, requirements for completing and EOT OMRA, relationships between the EOT OMRA and the Day of Discharge, how to bill an EOT OMRA reporting resumption, definition of a resumption of therapy, and change in ADL related to an EOT-R.  

You can read the Nov. 3, 2011, National Provider Call Transcript and Nov. 3, 2011, National Provider Call Training Slides

CMS has posted a video slideshow presentation from for this call on the “Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Minimum Data Set (MDS) 3.0 and Resource Utilization Group-Version 4 (RUG-IV) Policies and Clarifications” to the CMS YouTube Channel.

Sept. 30, 2011: An issue was identified with the calculation of the FY2012 transition RUGs values for a small percentage of assessments submitted following the Assessment Submission and Processing (ASAP) system enhancements on Sept. 18. 

According to the QTSO memo released Sept. 30, about 0.5% of the transition RUGs reported were incorrect because the FY 2012 transition RUG calculations used FY2011 CMS set codes instead of the FY 2012 CMI set codes. An email with instructions on how to proceed is being sent out to those SNFs that have been affected. QTSO has also released a list of SNF and Swing Bed Unit providers that have assessments affected by this issue.

Sept. 13, 2011: Aegis Therapies and LeadingAge held a webinar to present the major changes related to therapy services and provide steps on how to plan for them. With the implementation of the new prospective payment system Final Rule effective on Oct. 1, skilled nursing facilities will experience significant changes in the way they code and get paid for therapy services. 

Some of the most significant changes are the introduction of a new OMRA assessment related to therapy, an additional option for modifying the EOT OMRA assessment, and a new method for allocating group treatment minutes.

CMS has recently released a “Aug.23 2011 National Provider Call Follow-up” document with more clarifications on how to code the MDS 3.0.  This document includes clarifications on when the ARD must be set for certain assessments; the effect of Leave of Absence days; definition and how to allocate group therapy minutes; revised MDS assessment schedule; revised EOT policy, including the EOT-R; revised student supervision requirement; and more clarification of when the COT will be effective, when it’s necessary, how it affects payment, when it applies, what should be considered as part of the “intensity of therapy,” consideration of ADLs in the evaluation process, completion of interview questions, and other details of the COT evaluation process. 

August 15, 2011: CMS hosted a national provider call on the rule on Tuesday, August 23. Slides are now available. Subject matter experts discussed new MDS 3.0 policies, such as allocation of group therapy, student supervision, changes to the MDS 3.0 schedule, EOT OMRA, EOT-R, and the COT OMRA that will be implemented on October 1, 2011.

You can download the CMS Memo on Transition for Implementation of FY 2012 SNF PPS MDS Reporting Policies.

July 14, 2011: Appendix A and Section M have been updated to clarify the definition of 'worsening.' Pressure ulcer worsening is defined as a pressure ulcer that has progressed to a deeper level of tissue damage and is therefore staged at a higher number using a numerical scale of 1-4 (using the staging assessment determinations assigned to each stage; starting at the stage 1, and increasing in severity to stage 4) on an assessment as compared to the previous assessment. For the purposes of identifying the absence of a pressure ulcer, zero pressure ulcers is used when there is no skin breakdown or evidence of damage."

July 14, 2011: CMS posted 2 new training videos

June 11, 2011: CMS Memo: "The Use of Dashes in Completing the MDS 3.0 Assessment: Potential Impact to Beneficiaries and Nursing Home Facilities

CMS Errata Documents

Oct 5, 2011: This Errata document corrects errors identifying a list of errors of which all SNFs should be aware. The list includes: 

  • Chapter 3, Section O Page O-39 and O-40 Item O0600 and O0700: Physician Examinations and Physician Orders – in the first bullet under Coding Tips and Special Populations, the last sentence “Cannot be an employee of the facility” was added in error and should be ignored.
  • Page 2-52 Section 2.10 Combining Medicare Scheduled and Unscheduled Assessments: Under PPS Scheduled Assessment and Start of Therapy OMRA.
  • Page 2-53 Section 2.10 Combining Medicare Scheduled and Unscheduled Assessments: Under PPS Scheduled Assessment and End of Therapy OMRA.
  • Page 2-53 Section 2.10 Combining Medicare Scheduled and Unscheduled Assessments: Under PPS Scheduled Assessment and Start and End of Therapy OMRA.
  • Page 2-56 Section 2.11 Combining Medicare Assessments and OBRA Assessments: the text does not reflect the new PPS assessment schedule.
  • Page 2-58, Section 2.12 Medicare and OBRA Assessment Combination: under Medicare-required 14-Day and OBRA Admission Assessment the second and third bullets do not reflect the new PPS assessment schedule. 
  • Page 2-66 Section 2.12 Medicare and OBRA Assessment Combination: Under Change of therapy OMRA and OBRA Admission Assessment, the wrong Item is listed. Page 6-26 Section 6.6 RUG-IV 66 Group Model Calculations Worksheet for SNFs, under Calculation of Total Rehabilitation Therapy Minutes, RUG-IV, 66- Group. Hierarchical Classification, under Step #2 there is a typo where the word “alone” should be “one.” 

MDS 3.0 Helpful Hints Document

The "MDS 3.0 Helpful Hints Document" is an overview for providers of the steps required to submit an MDS 3.0 file, verify its submission status, and obtain a Final Validation report. The document states that it is strongly recommended that providers access and review the MDS 3.0 Resident Assessment Instrument Manual and the CASPER Reporting User’s Manual from the MDS 3.0 Welcome page, which can be accessed when nursing homes sign into CASPER.

MDS 3.0 Training Slides

Sept. 3, 2010: This file contains MDS 3.0 PowerPoint Training Slides to facilitate MDS 3.0 training.

The latest updates include revised versions of the following sections of the MDS 3.0 Training Slides: Chapter 3, Sections: A, B, C (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, M, N, O, P, Q, V, X and Z.

MDS 3.0 Instructor Guides

Sept. 3, 2010: The MDS 3.0 Instructor Guides facilitates MDS 3.0 training.

The latest updates include revised versions of the following sections: Chapter 3, Sections: A, B, C (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, M, N, O, P, Q, V, X and Z

MDS 3.0 Training Aides

Sept. 15, 2010: Contains algorithms and assessment aides that may be helpful when performing assessments or coding the MDS.

Training Videos

CMS YouTube training videos for MDS 3.0.

Other MDS Resources


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