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MDS 3.0 RAI User’s Manual Update: Expert analysis

The Centers for Medicare & Medicaid Services (CMS) recently released the MDS 3.0 RAI User’s Manual v1.11 Replacement Manual Pages and Change Tables and the RAI Manual v1.11 and Change Tables. The MDS 3.0 RAI Manual v1.11 Appendices A and F were also updated.

In addition to the Manual changes, there are changes to the MDS 3.0 form and the current version is v1.11.2

In case version numbers confuse you, here are the latest versions:

  • MDS 3.0 User’s Manual = v1.11
  • MDS 3.0 Item Sets (forms) = v1.11.2
  • MDS 3.0 Data Submission Specifications = v1.13.2
  • RUG-IV Specifications and DLL Package = v1.03.0
  • jRaven: Resident Assessment Validation and Entry = 1.1.8

General note: There are many changes for clarity, updated URLs, title size, and page length changes in this update.

Some of the important changes include:

  1. Privacy Act Statement: Health Care Records is replaced with the update issued: 9-6-12, Implementation / Effective date: 6-17-13
  2. COT: Change in language for clarity, but not real change in intent.
  3. Leave of Absence (LOA): Because of the differences required in determining ARD dates for LOA claims on scheduled and unscheduled PPS assessments, CMS has added some finite clarification and examples of how to approach ARD setting.
  4. ADL Coding: Coding instructions have been rewritten for clarity, removing barriers to coding improperly because or poorly worded instructions. Changes also offer process improvement tips that will result in accurate coding.
  5. ADL Scenarios: Five detailed ADL coding scenarios and rationales have been added to the Manual that deal with dressing (2), transfer, eating, and toileting. Each illustrates coding intricacies that plague facilities trying to obtain correct and accurate ADL scores.
  6. Toileting Trial: Improved language and definition.
  7. Section K:There are changes to 3 separate items in this section, including:
    1. K0510D: Adds food elimination diets related to food allergies as a therapeutic diet
    2. Item K0700 is replaced by K0710 on the MDS Item Set (form). This replacement changes coding from the last 7 days to 3 separate coding and calculations.
      1. Column 1 is in the last 7 days while not a resident
      2. Column 2 is in the last 7 days while a resident
      3.  Column 3 is in the last 7 days, regardless of whether a resident or not
    3. Item K0710 replacement in the Manual provides examples of how to calculate for the 3 columns
  8. Section M: Replaces the term ‘necrotic tissue’ with the term ‘eschar’ in both the Manual and item sets (forms).
  9. Item O04003A, B, C: Co-treatment minutes are to be captured for Speech, OT, and PT. Enter the total number of minutes each discipline of therapy was administered to the resident in co-treatment sessions in the last 7 days. This required both form and manual changes. CMS provided coding examples with blended methods of therapy delivery.
  10. Item O0400 Coding Tips and Special Populations, Minutes of Therapy: Added language that better aligns the MDS language with the IOM 100-02 Medicare Benefits Policy Manual language in Chapters 8 and 15 for therapy.
  11. O0420 Distinct Calendar Days of Therapy: This item has been added to the form and manual in order for the RUG algorithm to properly calculate a compliant RUG score. In the past, it was possible to produce a valid RUG score that did not meet the Medicare daily skilled therapy requirement of providing a minimum of 5 days of therapy under Medicare Part A. Examples are included in the Manual.
  12. Q0100, Q0500, Q0550: The Manual and Forms are all updated from ‘family or significant other’ to ‘family or significant other or guardian or legally authorized representative.’
  13. Z0400 Coding Tips and Special Populations: Discusses what to do when an individual who completed a portion of the MDS is unavailable to sign it (e.g., individual is on a medical leave or no longer employed by the facility).
  14. Chapter 6 RUG language: Reflects change to MDS items K0710, O0420, and ARD set outside the SNF Part A benefit on an LOA patient.

For continuing in-depth analysis of these changes, read our upcoming issues of PPS Alert for Long-Term Care!

Click here to purchase the revised MDS 3.0 RAI User’s Manual.