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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.

Wisconsin RAI/MDS items

Preadmission Screening and Resident Review (PASRR)

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 December 18, 2024, 1-2 p.m. Agenda (PDF)

Past forums and trainings

Training

View information from CMS with timely updates on MDS and related topics.

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.

Please reference our Manual Minimum Data Set (MDS) Deletion Request document that provides a detailed explanation of the process. If you have any further questions or need additional clarification, please email dhsdqamdsoasis@dhs.wisconsin.gov.

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.

Medicare

Medicaid

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

CMS Nursing Homes webpage includes links to the critical element pathways, CMS-802, and other valuable resources.

Other resources

Contact us

Questions? Email dhsdqamdsoasis@dhs.wisconsin.gov.

  • Heather Newton, RAI education coordinator, can answer questions about the RAI, coding MDS items, or clinically related information.
  • Emily Virnig, MDS automation coordinator, can answer technical or automation questions about submitting MDS records, interpreting validation report messages, and generating CASPER reports.

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.

Glossary

 
Last revised December 4, 2024