FREE MDS-Related, MDS Forms & Resources
MDS RAI MANUAL & ASSESSMENT FORMS
Finally, CMS released the RAI manual version 1.18.11 for October 2023:
Here's the draft of the RAI manual that has the revision: DRAFT RAI Manual version 1.18.11
Here's the FINAL draft of all the MDS assessment forms (zip file): DRAFT of the different MDS assessment forms version 1.18.11
Click here if you only want the FINAL DRAFT of the Comprehensive MDS Assessment version 1.18.11
Draft MDS 3.0 Item Set version 1.18.11 effective October 2023 (All Assessments): Here is the complete set of assessments, not just the Comprehensive Assessment that was posted in September 2022. Because it's a bunch, the link is a zip file.
Draft MDS 3.0 NC Item Set version 1.18.11 effective October 2023 (Comprehensive Assessment Only): Very similar to the draft version 1.18.0 released late 2019 and early 2020. (Scroll to the posting below on 12/27/2019 and 01/24/2020 to compare.)
No huge surprises from the 2020 draft!
A few points to consider:
- Draft version 1.18.11 is yet another draft of 1.18.
- Remember RCS-1 draft before PDPM? Changes may still happen.
- There is no official RAI manual update for guidance and instructions to go with these changes yet.
MDS 3.0 RAI User’s Manual (v1.17.1R) Errata (v2) Effective July 15, 2022
Section I coding guidance regarding misdiagnosing indications for antipsychotics, along with the previous errata v1.
RAI User's Manual v1.17.1R Errata v1
The NTA Comorbidity Score Calculation table on pages 6-30 and 6-31 needed to be updated to clarify that the presence of any, a combination, or all of Items M1040A, M1040B, and M1040C add one point consistent with the current PDPM GROUPER. (Or click here.)
MDS version 1.18.0 is on hold due to the covid emergency. Instead, CMS has posted the MDS version 1.17.2 changes for October 2020. There is no new RAI manual update of instructions regarding completion of that version 1.17.2. (See link below for zip file of MDS version 1.17.2).
May 15, 2020
In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications. These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1. This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models.
The changes to the technical data specifications that support these modifications are contained in the Errata v3.00.4 which can be accessed in the file: MDS 3.0 data specs errata (v3.00.4) Final 04-30-2020 in the Downloads section below. Supporting materials including the 1.17.2 Item Change History report and the revised 1.17.2 Item Sets can be accessed in the file: MDS 3.0 Final Item Sets v1.17.2 for October 1 2020 zip also posted in the Downloads section below.
Please confirm with your State Medicaid Agency if your State will be requiring the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment.
COVID-19 & MDS: BLANKET WAIVERS
Updates to Long-Term Care (LTC) Emergency Regulatory Waivers issued in response to COVID-19 terminated effective 05/10/2021-
• Waiver of requirements related to the timing of completing certain care plans.
• Waiver of the timeframe requirements for completing and transmitting resident assessment information (minimum data set (MDS)) in order to allow facilities to focus on resident care.
To see full documents, click on these links:
Covid-19 & MDS: Blanket waiver for all impacted facilities-
• Section 1812(f): This waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities).
• 42 CFR 483.20: This waiver provides relief to SNFs on the time frame requirements for Minimum Data Set assessments and transmission (Blanket waiver for all impacted facilities).
To see full document released today, click on this link:
MDS Item Sets 3.0 version 1.18.0 draft: Description of Changes document. Find out all the specific item changes such as "New item and responses added: A1010. Race What is your race? Check all that apply A. White B. Black or African American C. American Indian or Alaska Native D. Asian Indian E. Chinese F. Filipino G. Japanese H. Korean I. Vietnamese J. Other Asian K. Native Hawaiian L. Guamanian or Chamorro M. Samoan N. Other Pacific Islander X. Resident unable to respond."
MDS Item Sets 3.0 version 1.18.0 draft: The link is a zip file of all the MDS forms. Released by CMS today: "A new DRAFT version of the 2020 MDS item sets (v1.18.0) was posted. This version is scheduled to become effective October 1, 2020. Please note that Section G has been removed from all Federal item sets."
MDS 3.0 manual version 1.17.1 effective October 01, 2019: The complete final version with PDPM.
MDS 3.0 manual version 1.17.1 replacement pages of changes final release effective October 01, 2019: A file of what was added and clarified.
MDS Section I0020B effective October 01, 2019: A file listing the ICD-10 Codes to be used for MDS Item I0020B effective October 01, 2019 has been released by CMS 3 days ago. Click on links below for the cms.gov website, scroll to bottom of page and click on the PDPM_ICDCodes_for_I0020B_FY2020 file. (PDPM training attendees were emailed these files but may have been to large of a file.)
- ICD 10 for I0020B (Microsoft Access)
MDS 3.0 1.17 effective October 01, 2019: The preliminary version of the MDS manual with PDPM
MDS 3.0 version 1.16R Errata October 01, 2018 Pages ONLY: Yes, the new version 1.16 already has something changed: Section J Major Surgery criteria.
MDS 3.0 version 1.16 effective October 01, 2018: This is the complete final RAI manual. If you only need the new replacement pages version 1.16 effective October 01, 2018, click here. -MJ 08/29/18
MDS 3.0 version 1.16.0R effective October 01, 2018 Comprehensive MDS form: This is the draft of what was the "final" version of a former draft. So yes, this has been revised a few times. Don't count on it being the final one yet. - MJ 07/05/18.
CMS memo about the audit of inaccurate coding of Schizophrenia in MDS to adjust Quality Measure ratings.
State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities Rev. 10/21/2022 - Final
Since the Five-Star Users' Guide has been updated so many times, find the latest version in the Five-Star Quality Rating System page:
Advanced copy of the State Operations Manual
Five Star Users' Guide Effective January 2022
MDS QM User’s Manual V15 Effective 01-01-2022 (ZIP) includes the MDS 3.0 QM User’s Manual V15.0, which contains detailed specifications for the MDS 3.0 quality measures, as well as the Quality Measure Reporting Module Table that documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. MDS QM User’s Manual V15 Effective 01-01-2022 (ZIP) also includes the Risk Adjustment Appendix File for MDS 3.0 Quality Measure User’s Manual V15, which contains the logistic regression coefficients used to risk adjust the Percent of Residents Who Made Improvements in Function (SS), Percent of Residents Whose Ability to Move Independently Worsened (LS), and Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder (LS) measures. MDS 3.0 QM User’s Manual V15.0 Effective 01-01-2022 (ZIP) is available under the Downloads section of this webpage.
Released today: Temporary SNF QRP Exceptions Due to the COVID-19 PHE Public Reporting Final Tip Sheet. This tip sheet lists the temporary changes to the SNF QRP data submission requirements, due to the COVID-19 PHE, to assist skilled nursing facility providers while they directed resources toward caring for patients and ensuring the health and safety of patients and staff. CMS made optional and temporarily excepted providers from the submission of the MDS assessment data.
The Centers for Medicare & Medicaid Services is releasing three short video tutorials to assist providers with coding Section GG. These videos, ranging from 5 to 10 minutes, are designed to provide targeted guidance using simulated patient scenarios. To access the videos, click on the links below:
· GG0130H. Putting on/taking off footwear.
· GG0170L. Walking 10 feet on uneven surfaces.
If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Quality Reporting Program Help Desk for your care setting.
The PAC Training Team
The Centers for Medicare & Medicaid Services recently released a short video tutorial to assist providers with coding GG0130A. Eating. This 6-minute video is designed to provide targeted guidance using simulated patient scenarios. To access the video, click on the link below:
· Coding GG0130A. Eating (6:19)
Other resources available to assist providers in coding Section GG can be accessed by clicking on the following links.
· Updated Section GG Web-Based Training Course
· Additional video tutorials:
Coding GG0110. Prior Device Use with Information From Multiple Sources (3:58)
Decision Tree for Coding Section GG0130. Self-Care and GG0170. Mobility (11:56)
Coding GG0130B. Oral Hygiene (4:25)
Coding GG0170C. Lying to Sitting on side of bed (4:33)
Medicare Program Final Rule FY2019 for PPS in the Federal Register.
New LTC survey process directs DHS Facility Evaluators to utilize the LTC Survey Critical Pathway for Resident Assessments.
Need a sample of a Baseline Care Plan? Click here. Don't forget to email us that you are using it so that we can notify you of edits or revisions to the form by the time November 28, 2017 rolls around. The form is just a guide showing the MINIMUM required. Want to see a sample Baseline Care Plan as the summary? Click here. Email us that you are using these forms so you can be notified of revisions.
Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1765-F)
CMS issued the Fiscal Year (FY) 2023 Skilled Nursing Facility (SNF) Prospective Payment System final rule to update payment policies and rates. See a summary of key provisions effective October 1, 2022:
2.7% net payment rate increase for skilled nursing facilities
Patient Driven Payment Model parity adjustment recalibration (use the FY 2023 proposed rule calculator to learn more) and changes in ICD-10 code mappings
Permanent 5% cap on annual wage index decreases
SNF Quality Reporting Program: compliance date revisions for certain requirements, new influenza vaccination coverage for health care personnel measure, and regulation text revisions
SNF Value Based Purchasing: not apply the SNF 30-Day All Cause Readmission Measure for the FY 2023 program year and add 3 new measures for FY 2026 & 2027 program expansion years
FY 2022 PDPM ICD-10 Mappings (ZIP) (revision posted 09-27-2021)
1. Updated all three mappings to FY2022 code list.
2. Reflected all changes finalized in the FY2022 SNF PPS Rule.
09/09/21 (FYI only. See above for updates.)
FY 2022 PDPM ICD-10 MAPPINGS (zip file) effective 10/01/2021:
1. Updated all three mappings to FY2022 code list.
2. Reflected all changes finalized in the FY2022 SNF PPS Rule.
FY 2021 PDPM ICD-10 MAPPINGS (zip file) effective 01/01/21:
1. Updated all three mappings to FY2021 code list.
2. Reflected all changes finalized in the FY2021 SNF PPS Rule.
3. Updated mappings with changes based on the announcement of new ICD codes for coronavirus 19 effective January 1st 2021 (https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-19-508.pdf). The codes affected are found in the Clinical Category and NTA Comorbidity tabs. The mapping is subject to change pending the release of coding guidelines for these new codes.
FY 2021 PDPM ICD-10 MAPPINGS (zip file):
1. Updated all three mappings to FY2021 code list. 2. Reflected all changes finalized in the FY2021 SNF PPS Rule.
FY 2020 PDPM ICD-10 MAPPINGS: Updated as of 03/31/2020.
PDPM SNF PPS Booklet: Print-friendly html version or colorful, brochure-like version.
PDPM: On 08/30/2019, CMS updated the PDPM page: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html
The major BIMS clarification and other changes can be found in the file below. The file shows the changes CMS has on their previous Q&A as "red-lined":
PDPM FAQ Sheet Updated by CMS 08/30/2019
The most recent Case Mix Index Rates update can be found in this PDPM Fact Sheet Template file:
PDPM Classification as of 08/30/2019
The ICD-10 mappings file have been updated as well. Please visit the cms.gov PDPM webpage mentioned.
Above are the most important updates. Please review the other files in the cms.gov PDPM website for other minor updates.
PDPM: This is free forms page. To purchase the PDPM "Cheat Sheet"/ Guide/ Worksheet used for calculating the PDPM classification, click here to go to the store.
PDPM: The one and only source for all things PDPM is and should be CMS. The main point of reference is a cms.gov webpage, specifically here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html. Below are some the most important reads from the site:
- PDPM ICD-10 Mappings
- PDPM FAQS
- PDPM Patient Classification
Word of caution: The PDPM Presentation on that aforementioned cms.gov page is old so it does not have the most updated information.
UPDATED Coding Guidelines for COVID-19 Effective April 1, 2020
ICD-10-CM Update Related to Vaping or E-cigarette: Released today: Official Coding Guidelines - Supplement Coding encounters related to E-cigarette, or Vaping, Product Use. Purpose: Official diagnosis coding guidance for healthcare encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI). To view, click here.
ICD-10-CM: FREE ICD-10-CM from cms.gov here. Choose this file on that webpage:
- 2020 Code Tables and Index [ZIP, 20MB]
This is one of the ICD-10-CM files from the zip file:
- 2020 ICD Index
ARCHIVED: MDS MANUALS & FORMS
Links to old files:
MDS 3.0 version 1.15R effective October 01, 2017 (R): This is the latest MDS RAI manual version released for Oct. 2017 and revised Dec. 15, 2017 all together as one.
Concerns regarding recent coding convention update in relation to coding UTI brought up during our November 2017 Refresher Courses clarified: MDS 3.0 RAI User’s Manual (v1.15R) Errata (v1) Effective December 15, 2017.
MDS 3.0 version 1.15 effective October 01, 2017.
MDS 3.0 version 1.16 effective October 01, 2018: Major changes in MDS has already finalized.
MDS 3.0 Comprehensive Assessment version 1.15 draft October 2017 release.
RAI Manual Appendix B updated December 15, 2016.
Section GG clarification: If a person's clinical functional assessment can be completed and usual performance determined on day 1 it is acceptable to document that in Section GG. (I provided this instruction during my August 2016 Refresher Course while other webinars said all 3 days is a must.)
Oct 2016 Section GG supporting documentation guide. Feel free to use:
CMS Q&A from Illinois SNF QRP August 24, 2016 training (released September 08, 2016):
• Part A PPS Discharge Combinations • Section GG • SNF QRP Pressure Ulcer quality measure
MDS 3.0 RAI Manual v1.14 FINAL release for October 2016
New Section N finalized item set for FY2017:
Section N for SNF QRP new Quality Measure regarding clinically significant medication issues.
MDS 3.0 Item Set Version 1.140 effective October 01, 2016. All MDS Assessment Forms released Aug 10, 2016 and considered FINAL:
MDS 3.0 RAI Manual v1.14 DRAFT for October 2016
Latest news regarding MDS forms: New PPS Part A Discharge End of Stay: Draft only- Take a look at a preview of the new PPS discharge assessment effective October 2016! (posted 04/2016)
Latest news regarding MDS forms: Section C: Draft only- Take a look at a preview of the comprehensive MDS Section C! Psychomotor retardation in Section C1300 will not be included effective October 2016 thus no longer a trigger for the following CAAs: Delirium and Cognitive Loss/Dementia. (posted 04/2016).
Latest news regarding MDS forms: Section GG: Draft only- Take a look at a preview of the new Section GG! (posted 04/2016)
MDS 3.0 RAI Manual October 2015-
MDS 3.0 RAI Manual v1.13 and Change Tables October 2015 : After you click on link above, go to bottom of that CMS.gov website page, look for a couple of zip file links and download. One link is a file that specifies the new or edited parts of the RAI manual. Another link has the revised (replacement) pages to replace the older ones from the October 2014 version. (Links may change over time as CMS.gov constantly updates their website.)
MDS / Staffing Focused Survey Announcement from CMS Oct 2014
RUG-IV PPS Classification Guide- This is the most thorough yet simple, color-coordinated PPS Guide ever! I've come across many different ones over the years but after reviewing others I've used in the past, I've found some mistakes! So I've decided to make one myself. Apologies for the previous attendees whom I did not get a chance to give this copy to... Well, this one is for all of you!
"California MDS Nuggets" Newsletters:
CDPH MDS Newsletter 2013 (New policies for Modification/ Inactivation requests)
ARCHIVED: MDS-RELATED PUBLICATIONS
Links to old files:
Proposed changes of PPS RUG-IV to RCS-1: Federal Register Document
Mega Rule Phase 1 (2016) & Phase 2 (2017): Revised Interpretive Guidance for Nursing Homes and New Survey Process as of July 25, 2017 from Division of Nursing Home Survey and Certification Group
Training for Phase 1 Implementation of New Nursing Home Regulations effective starting November 28, 2016:
CMS Memo announcing surveyor and providor training access.
Web-based training: Addresses the new language included in the New Nursing Home Regulations, and how Phase 1 will be implemented via the State Operations Manual, F-Tags, and survey process.
Quality Measure regarding Pressure Ulcers that are New or Worsened (Short-Stay) (NQF #0678) has changed as of August 2016. Click here to view.
5-STAR Users Guide revised as of August 01, 2016
30-Day Potentially Preventable Rehospitalization Measure as of July 2016
New Quality Measures for Nursing Home Compare as of April 27, 2016. - These are the ones mentioned in the March 03, 2016 update below that came to fruition.
Quality Measures effective April 01, 2016: New QM manual now available here.
Quality Measures update as of March 03, 2016: Long Term Care/Nursing Home 5-STAR Quality Rating System will have 6 new quality measures on Nursing Home Compare by April 2016 per CMS. Check out more information here.
Quality Measures effective October 01, 2015
Medicare Benefit Policy Manual Chapter 8
Medicare Coverage of Skilled Nursing Facility booklet a lay person can understand.
State Operations Manual (SOM) Long Term Care Facilities (Rev 06-10-16)
State Operations Manual (SOM) Long Term Care Facilities (Rev 10-09-15)