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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.

The MDS 3.0 RAI Manual (PDF) is available under Related Links on the CMS MDS 3.0 RAI Manual webpage.

The MDS 3.0 Final Item set v1.17.2, dated October 1, 2020, is available under Downloads on the CMS MDS 3.0 RAI Manual webpage. Draft item set v1.18.11 Oct2023 is also available for download.

The MDS Item Sets and Data Submission Specifications can be downloaded from the CMS MDS 3.0 Technical Information webpage.

Wisconsin RAI/MDS items

Preadmission Screening and Resident Review (PASRR)

Wisconsin does not have a Section S for MDS 3.0.

Wisconsin does not require the submission of State Optional items.

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 15, 2023, 1-2 p.m. Agenda (PDF)

Past forums and trainings

Training

January 2023

December 2022

November 2022

October 2022

Only Omnibus Budget Reconciliation Act (OBRA) and Medicare Prospective Payment Systems (PPS) assessments are allowed to be submitted.

  • All Medicare and/or Medicaid certified Swing Beds, or agents of those facilities must transmit required MDS data to the CMS Quality Improvement and Evaluation System (QIES) Assessment and Submission and Processing (ASAP) system. 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 including Medicare Advantage plans).
  • Test data should not be submitted to the QIES ASAP system. 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.

QIES Technical Support Office (QTSO) Submission Information and User's Guide

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 is moving toward 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.

All providers must request a CMSNet User ID to access secure CMS websites for submissions and reports unless another secure connection has been established. Account registration instructions are on the QTSO MDS Individual Access webpage.

Please reference Certification And Survey Provider Enhanced Reports (CASPER) Reporting User's Guide For MDS Providers for information on creating a CASPER account.

Medicare

Medicaid

  • MDS 3.0 Section Z items Z0200 and Z0250 don't have to be coded and may be left blank.
  • Wisconsin Medicaid uses the MDS 3.0 HIPPS code generation for Medicaid residents.

The Program Participation System (PPS) was discontinued in 2021, and the automated referral system implemented in October 2021. Due to customer and provider feedback it has been determined that a new process will be implemented for Section Q referrals as of Dec. 1, 2022.

  • MDS referral process
    • The nursing home completed 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. For questions regarding county of responsibility contact (include contact information).
    • Include the resident's face sheet, current diagnoses, activated pow 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

For questions about the RAI, coding MDS items, or clinically related information contact Heather Newton, RAI education coordinator:

For technical or automation questions about submitting MDS records, interpreting validation report messages, and generating CASPER reports, contact Emily Virnig, MDS automation coordinator:

Last revised February 7, 2023