Nursing Homes: RAI/MDS 3.0 Information
These links provide information on the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) 3.0. Many of the links will exit the Wisconsin Department of Health Services (DHS) website.
CMS RAI/MDS items
The CMS MDS 3.0 RAI Manual webpage includes the current version of the MDS 3.0 RAI Manual and associated documents. The CMS webpage will be updated with important information regarding the MDS 3.0 RAI Manual that needs to be communicated. Here are some links for your easy access:
- MDS 3.0 RAI User's Manual Version 1.18.11 (PDF) effective October 1, 2023
- MDS 3.0 RAI User's Manual (Errata v3.01.4) (PDF)
- MDS 3.0 Item Sets version v1.18.11 v6 (ZIP)
- MDS 3.0 Item Set Change Table Supplement v1.18.11 v6 (PDF)
- Draft Item Matrix v1.19.1 (PDF) for October 1, 2024
- Draft Item Sets v1.19.1 (ZIP) for October 1, 2024
Wisconsin RAI/MDS items
Preadmission Screening and Resident Review (PASRR)
- PASRR Level 1 screening submission and reimbursement available through the ForwardHealth portal – Update 2023-37 (PDF) and PASRR User Guide (PDF)
Wisconsin does not have a Section S for MDS 3.0.
Wisconsin will not require the completion of the Optional State Assessment (OSA).
RAI/MDS educational forum
The Division of Quality Assurance (DQA) sponsors a quarterly forum to help nursing homes stay updated with evolving RAI/MDS information. The forum also gives nursing home staff a chance to ask questions. The forum is hosted jointly by DQA's RAI/MDS education and automation coordinators.
To attend:
- Join Zoom forum. (Select this link to go straight to the room. No need for a meeting ID and password.)
- Meeting ID: 160 836 5011
- Passcode: 048192
- Join by Phone: 551-285-1373
- Enter 1608365011 # when asked for the meeting ID
- Enter 048192 # if asked for passcode
- Enter # if asked for participant ID
- The next forum is scheduled for March 20, 2024, 1-2 p.m. Agenda (PDF)
Past forums and trainings
- December 20, 2023
- September 13, 2023
- June 21, 2023
- June 21 recording
- June 21 agenda (PDF)
June 21 slide presentation (PDF)
Question: If a resident sleeps in a recliner, how would we code bed mobility?
Answer: If the resident doesn't sleep in a bed, clinicians should assess bed mobility activities using the alternative furniture on which the resident sleeps (for example a recliner).Question: If a resident was living at home, went to the ER, and then was admitted to the NF, how would we code A1805 Entered From? Would it be home or hospital?
Answer: Page A-36 of the RAI draft manual indicates to best describe the setting the resident was in immediately prior to facility admission/entry or reentry. So in this example, hospital would be the correct code.
- March 15, 2023
Training
- MDS 101 Session 1 recording and June 28, 2022 slide presentation (PDF)
- MDS 101 Session 2 recording and August 31, 2022 slide presentation (PDF)
- MDS 101 Session 3 recording and October 25, 2022 slide presentation (PDF)
- MDS 101 Session 4 recording and February 1, 2023 slide Presentation (PDF)
- CMS MDS 3.0 Training
- CMS Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Training provides links to trainings such as:
- Cognitive and mood assessment
- Achieving a full annual payment update
- Section J
- Section N
- Section GG
- DHS Nursing Home Pressure Injury Information
View information from CMS with timely updates on MDS and related topics.
February 2024
- SNF QRP Listening Session Summary: Possible Expansion of MDS Data Submission to All SNF Residents Regardless of Payer (PDF)
- 2024 POA Exempt Codes (ZIP)
- 2024 Conversion Table - UPDATED 09/21/2023 (ZIP)
- 2024 Addendum - UPDATED 02/01/2024 (ZIP)
- 2024 Code Descriptions in Tabular Order - UPDATED 02/01/2024 (ZIP)
- 2024 Code Tables, Tabular and Index - UPDATED 02/01/2024 (ZIP)
- FY 2024 ICD-10-CM Coding Guidelines - UPDATED 02/01/2024 (PDF)
- SNF QRP Data Collection & Final Submission Deadlines for the FY 2026 (PDF)
- FY2024 ICD-10-CM Codes – April 1, 2024, Release
January 2024
- What to Know about Nursing Home Staffing Minimums
- Schizophrenia Facts (PDF)
- General Explanation of the Major Categories for SNF Consolidated Billing (PDF)
- Error Message Reference Guide (PDF)
- Draft MDS 3.0 Item Sets V1.19.1 (ZIP)
- Draft Item Matrix v1.19.1 (PDF)
- CMS Health Equity Confidential Feedback Report Frequently Asked Questions (FAQ) Document (PDF)
- CMS Health Equity Confidential Feedback Report Methodology Report (PDF)
December 2023
- SNF QRP Claims-Based Measures Specifications Manual (PDF)
- SNF QRP Claims-Based Measures Supplemental Files (ZIP)
- FY24 VBP Year Fact Sheet (PDF)
- FY24 VBP Year Timeline (PDF)
- Confusion Assessment Method (CAM) Video Tutorial
September 2023
- Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Change Table Version 5.0 (PDF)
- Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 5.0 (PDF)
- QRP Data Elements Affecting FY2026 APU Determination (PDF)
- QRP Data Elements Affecting FY2025 APU Determination (PDF)
- Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions (FAQs) Current as of 10/01/2023 (PDF)
- MDS 3.0 Quality Measures User’s Manual v16 (PDF)
- SNF 30-day All-Cause Readmission Measure v2.0 (PDF)
- Skilled Nursing Facility Value-Based Purchasing Program: Frequently Asked Questions (FAQs) (PDF)
- PDPM Grouper Jar Package v2.2000 (ZIP)
- PDPM ICD-10 Mappings FY24 (ZIP)
- COVID-19 Vaccination Modules: Understanding Key Terms and Up to date Vaccination (PDF) from the National Healthcare Safety Network (NHSN)
- Interview for Daily and Activity Preferences Cue Card (PDF)
- Brief Interview for Mental Status (BIMS) When Administered in Writing Cue Cards (PDF)
- BIMS and BIMS Summary Score: Stopping and Coding an Incomplete Interview Explainer Video
- Pain Assessment Interview Cue Cards (PDF)
- PHQ 2 to 9 Cue Cards (PDF)
- Understanding Coding for N0415 - High-Risk Drug Classes: Use and Indication
- Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide (PDF)
- QSO-23-21-NH Updates to Nursing Home Care Compare Staffing and Quality Measures (PDF)
August 2023
- Wage Index Tables for FY 2024-Final (ZIP)
- PDPM Case-Mix Adj. Federal Rates (ZIP)
- FY24 Program Year Fact Sheet SNF VBP (PDF)
- SNF VBP Performance Score Report User Guide FY24 (PDF)
- HCPCS Codes for SNF CB October 2023 (PDF)
- SDOH Explainer Video
- FY23 State Performance Standards System (SPSS) Guidance (PDF)
- SNF VBP FY24 Program Year Incentive Payment Multiplier Calculation (PDF)
- MDS 3.0 Frequency Report Website
- MDS Frequently Asked Questions for Providers V1.2 (PDF)
- Five-Star State-Level Health Inspection Cut Point Table – August 2023 (PDF)
- PDPM ICD Codes FY24 (ZIP)
July 2023
June 2023
Submitting MDS assessments to the Internet Quality Improvement and Evaluation System (iQIES)
On April 17, 2023, CMS transitioned MDS record submissions and reports to iQIES. More information about the transition can be found in the What to Expect with the MDS Transition to iQIES (PDF) news article. The QTSO webpage for Nursing Home (MDS)/Swing Bed Providers Reference & Manuals has iQIES MDS FAQ documents, iQIES MDS User Guides and Manual, and other resources. The iQIES MDS Upload an Assessment User Manual (PDF) is available to guide you through uploading MDS assessments to iQIES.
Only Omnibus Budget Reconciliation Act (OBRA) and Medicare Prospective Payment Systems (PPS) assessments are allowed to be submitted.
- Nursing homes are required to submit OBRA required MDS records for all residents in Medicare or Medicaid certified beds regardless of payer source. Skilled nursing facilities (SNFs) and non-critical access hospitals (non-CAH) with a swing bed agreement (swing beds) are required to transmit additional MDS assessments for all Medicare beneficiaries in a Part A stay reimbursable under the SNF Prospective Payment System (PPS). Additional information related to transmitting MDS Data is in Chapter 5 of the MDS 3.0 RAI Manual (PDF).
- Do not submit assessments that are completed for purposes other than OBRA and SNF PPS (such as private insurance and Medicare Advantage Plans (for example: Medicare Part C)).
- Test data should not be submitted to iQIES. Please review 5.8 Special Manual Record Correction Request (PDF) for additional information.
MDS correction policy
The MDS correction policy is described in the MDS 3.0 RAI Manual (PDF) under Chapter 5.5 MDS Correction Policy. Please be aware that the corrective action will depend on the type of assessment. If you have submitted a combined assessment (OBRA and PPS), you may modify the submission to remove the PPS. If you have submitted a standalone PPS, you will need to complete a manual deletion.
QIES Technical Support Office (QTSO) references
Find technical guidance (such as references and manuals, software tools, and training materials) on the QIES Technical Support Office (QTSO) website. See the QTSO Nursing Home (MDS)/Swing Bed Providers page for more details.
CMS user account registration
QTSO uses a single sign-on option to access the secure side of the website. Providers will need to register for a Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) account. You will also need to request user roles. The Upload an Assessment User Manual (PDF) has details on the role needed to upload assessments. The User Roles Matrix Job Aid (PDF) has a full listing of all user roles and privileges in iQIES.
- The MDS 3.0 Quality Measure User's Manual is under Downloads on the CMS Quality Measures website.
- The iQIES Reports User Manual (PDF) provides information for how to generate the MDS 3.0 Quality Measures reports.
- Medicare Nursing Home Compare
- CMS Five Star Rating System
- CMS Nursing Home Quality Initiative
- Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Measures and Technical Information
- CMS Nursing Home Quality Assurance & Performance Improvement (QAPI)
- Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Public Reporting includes information for Provider Preview Reports
Medicare
- CMS SNF PPS
- Patient Driven Payment Model
- Medicare Benefit Policy Manual Chapter 8 (PDF)
- Medicare Claims Processing Manual Chapter 6 (PDF)
- National Government Services - Medicare claims
- Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program
Medicaid
- Wisconsin Medicaid uses the MDS 3.0 HIPPS code generation for Medicaid residents.
MDS referral process
- The nursing home completes the MDS assessment.
- If the resident expresses they would like to talk to someone about returning to the community, complete Nursing Home MDS 3.0 Section Q Referral and Non-MDS Q Referral, F-00311 (Word) to refer a resident to the Aging and Disability Resource Center (ADRC).
- Submit the form to the county of responsibility of the resident.
- Include the resident's face sheet, current diagnoses, activated power of attorney documentation, guardianship court order, protective placement court orders, and other documents specific to this referral as applicable.
- Completed form must be submitted by fax or email within 10 business days of completing the Section Q of the MDS Assessment.
- View Find my ADRC to locate ADRC contact information.
- See form for more detailed instruction.
Non-MDS referral
- A non-MDS Q is when a resident requests to talk with someone separate from the MDS Section Q assessment and shall be treated the same as an MDS referral.
- See form for more detailed instruction.
- The ADRC will follow up as necessary with the customer and the nursing home.
- The ADRC will document the referral outcomes.
Other resources
CMS resources
- Skilled Nursing Facility Center
- SNF/Long Term Care Open Door Forum
- CMS SNF Consolidated Billing
- Nursing Home Certification and Compliance
- State Operations Manual (SOM) and SOM Appendix (PDF)
- CMS Policy & Memos to States and Regions
- CMS Staffing Data Submission PBJ (QTSO Reference & Manuals webpage)
- Medicare Learning Network
CMS Nursing Homes webpage includes links to the critical element pathways, CMS-802, and other valuable resources.
Other resources
- DQA Email Subscription Service (Listserv)
- The Wisconsin Health Care Association (WHCA) / Wisconsin Center for Assisted Living (WiCAL) is a non-profit organization dedicated to representing, protecting, and advancing the interests of Wisconsin's long-term care provider community and the residents they serve.
- Metastar - Wisconsin's Quality Improvement Organization
- Clinical Resource Center
Contact us
For questions about the RAI, coding MDS items, or clinically related information contact Heather Newton, RAI education coordinator:
- Email heathera.newton@dhs.wisconsin.gov.
- Call 920-360-6102.
For technical or automation questions about submitting MDS records, interpreting validation report messages, and generating CASPER reports, contact Emily Virnig, MDS automation coordinator:
- Email emily.virnig@dhs.wisconsin.gov.
- Call 608-266-1718.
Patient names and other protected health information (PHI) should only be sent to individuals authorized to receive that information, so care must be taken to ensure the email is addressed correctly. Sending an email containing PHI to an incorrect recipient would be an unauthorized disclosure and a violation of HIPAA. We strongly recommend that you do not include PHI in an email. You may include the resident or assessment identification number.