RAI/MDS 3.0 Information

This web page provides links to information pertaining to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) 3.0.  Many of the links on this web page will exit the Wisconsin Department of Health Services website.

RAI/MDS Items

MDS-Basics 2013 provider training program sponsored by DQA

The RAI Manual is available as a zip file under the Downloads area of the CMS MDS 3.0 RAI Manual website (exit DHS). 

CMS PowerPoint slides identifying changes to MDS 3.0 Manual Modification/Inactivation policy, effective May 19, 2013 (exit DHS).

New version of MDS Item Sets/Subsets to become effective October 1, 2013 - Available for download from the CMS MDS 3.0 Technical Information website (exit DHS).

Clarification of MDS 3.0 coding of I5100, Quadriplegia

CMS has received several questions regarding coding of MDS item I5100, Quadriplegia. In order to provide guidance to States and providers, in March, 2013 CMS has discussed this issue in several venues and has provided the guidance below regarding coding this item.

In order to code I5100, Quadriplegia on the MDS, there must be a physician-documented diagnosis of Quadriplegia (proper). No diagnoses are defined in the RAI User’s Manual as it is up to the physician to medically determine and document the resident’s diagnoses. Physicians make diagnoses according to their assessment of the resident. Coding quadriplegia is limited to spinal cord injuries and must be a primary diagnosis and not the result of another condition.

If an individual has a severe debilitating diagnosis with a functional deficit that renders him/her functionally immobile such that it would cause a similar appearing paralysis as would be seen in a quadriplegic, it is the diagnosis of that condition that is coded on the MDS.

Examples:

• A resident with a diagnosis of Cerebral Palsy spastic quad type, would be coded under I4400, Cerebral Palsy.
• A resident with severe rheumatoid arthritis would be coded under I3700, Arthritis.
• A resident with End Stage Alzheimer’s would be coded under I4200, Alzheimer’s Disease.

It would be inappropriate to code the functional status or symptoms associated with the debilitating diagnoses noted in the above examples under I5100, Quadriplegia.

If there is a physician-documented diagnosis of functional quadriplegia that is a secondary to a debilitating disease as described above, this diagnosis can be coded in I8000, Additional active diagnoses by entering the appropriate ICD code for functional quadriplegia in the spaces provided.

The clarifications will not be included in the spring 2013 RAI User’s Manual update but CMS will continue to evaluate if additional language regarding coding Quadriplegia will be included in a future version.

RAI Panel Q&As

The RAI Panel consists of several State RAI Education Coordinators that provide consultation to CMS and answer questions related to RAI/MDS issues.

RAI Panel Q&As for January, February, March 2012  (PDF, 161 KB)

RAI Panel Q&As for August, 2011 (PDF,56 KB)

RAI Panel Q&As for July, 2011 (PDF,75 KB)

RAI Panel Q&As for June, 2011 (PDF,122 KB)

VIVE - Video on Interviewing Vulnerable Elders was funded by the Picker Institute and produced by the UCLA/JH Borun Center.  The VIVE video can be accessed on the Picker Institute website at http://pickerinstitute.org/vive/ (exit DHS).

Section Q

DQA/DLTC Joint Memo# 12-009 MDS Section Q Referral to Local Contact Agency Process and Automated Submission, issued 06/26/12

MDS 3.0 Section Q Referral Automated Process Information/Instructions

CMS Section Q Implementation Questions and Answers December 2010 to June 2012 (PDF,379 KB)

CMS Section Q Brochure (exit DHS)(PDF,97 KB)

CMS Community Living Initiative and additional Section Q resources/information (exit DHS)

Connection to Community Living (nursing home relocation initiative)

Section S and State Optional Items

Wisconsin will NOT have a Section S for MDS 3.0 and will not be adding State Optional items to any of the item sets.

Provider Educational Opportunities

MDS-Basics 2013 provider training program sponsored by DQA.

CMS has made available YouTube Training Videos for MDS 3.0 on the CMS MDS 3.0 Training web page.(exit DHS)

  June 6, 2013 CMS added a new YouTube video - Discharge Assessments and the Use of Dashes (exit DHS)

CMS Security Change effective March 29, 2013, may affect providers access to their network while connected to the CMS MDS/OASIS/CASPER systems, including access to submission files stored in a network drive/folder, saving files to their network, and printing on a network printer. Refer to the QTSO CMSNet Information web page for additional information including a CMSNet Work-Around document. (exit DHS) 

Only OBRA and Medicare PPS Assessments Allowed to be Submitted

On the January, 2011, SNF Open Door Forum conference call, CMS explained only MDS 3.0 assessments that are OBRA assessments or Medicare Part A PPS assessments should be submitted to the QIES ASAP MDS System. Assessments completed for Medicare Advantage Plans or for other insurance purposes should not be submitted. Additional information related to Transmitting MDS Data is identified in Chapter 5 of the RAI Manual.

Note: OBRA assessments are required to be completed and submitted for all residents regardless of payer source.

Change in MDS Correction Policy

Effective with submissions on April 1, 2011, CMS will no longer allow facilities to modify the MDS 3.0 reason for assessment items, assessment reference date (ARD), discharge date, and entry date. If a modification record is submitted attempting to change any of these items, the record will be rejected. These MDS items must be corrected by inactivating the old record and submitting a new record. Chapter 5 of the RAI manual will be revised to reflect this change.

Submission Information

CMS has developed a MDS 3.0 Submission, Submission Status, and Final  Validation Reports Helpful Hints (PDF, 798 KB) document that provides information for how to:

• Submit MDS 3.0 files after using the link on the MDS 3.0 Welcome Page

• Obtaining submission acknowledgement message including the Submission ID

• Use Submission Status to determine if the submission file was processed successfully

• How to obtain Final Validation reports in the Folders tab of CASPER

• How and when to use the MDS 3.0 Submitter Final Validation Report for instances when a normal Final Validation is not generate or if records in a submitted file are not included in a Final Validation report.

QIES Technical Support Office (QTSO) Website

The MDS Provider User's Guide is available under the MDS 3.0 link on the QIES Technical Support Office website (exit DHS).  This guide provides detailed information for the submission of MDS 3.0 records by nursing home and swing bed providers.  The Error Messages are located in Chapter 5 of the MDS Provider User's Guide.

The QTSO website also includes a link for RAVEN (exit DHS) software and there is also a webpage for Vendor MDS Information (exit DHS) including Question and Answer documents from CMS/Vendor teleconferences.

User IDs/Passwords Required

Users must have both a CMSNet (Verizon) User ID and a MDS Personal Login ID to submit MDS records/and or to access CASPER reports.  Both of these IDs and passwords are assigned to an individual and should not be shared.  

CMSNet (Verizon) User ID

A CMSNet (Verizon) User ID and password are required to access the CMS MDS System for submission of MDS records and/or to access CASPER Reports.  New users need complete the CMSNet Access Request Form to obtain an account.  This form and an Installation Guide are available on the QIES Technical Support Office (QTSO) website at:   https://www.qtso.com/cmsnet.html#CMSNetForm

MDS Individual Login ID Requirement

A MDS Individual Login ID is required in order to access the MDS Submission System and CASPER Reports. In order to acquire an Individual Login ID, a request must be submitted to the QIES Technical Support Office using the MDS Individual User Account Request Form available on the QIES Technical Support Office (QTSO) website at  https://www.qtso.com/accessmds.html (exit DHS). 

A facility is allowed to have a maximum of two Individual Login IDs. It is the facility’s responsibility to revoke access for any users who no longer require access to facility data.  Revoking the account of a user who no longer requires access to facility data permits you to request a individual login ID for an additional user.

MDS Individual Login Passwords

A user selects their own individual login password when they register for a MDS individual login account.  The password must meet stringent password rules that are available to view on the password web page.  Passwords are set to expire in 60 days.  Users must enter a new password when they are prompted to change their password or they may use the QIES User Maintenance application that is available on the MDS Welcome Page to change their password at any time prior to the 60 day expiration date.  

Forgot MDS Individual Login Password and Inactivated Accounts

If the incorrect individual login password is entered too many times, the account will be made inactive.  If the user does not log into CASPER reports within 90 days, their account will also be made inactive.  Inactive accounts will not be able to submit MDS assessments.

One indication of an inactive account or an expired password: after attempting to login the following message appears, "Authorization Required", indicating the server can't verify the appropriate access credentials.  

To reactivate a MDS personal account, follow these steps:

1. On the State MDS Welcome page select the QIES User Maintenance link.
2. Select  "Forgot your password or Inactive Account?".
3. Enter your Personal Login ID and answer the three security questions and follow the directions provided.

Providing answers to the security questions were part of the process for registering for an individual MDS account.  Users will have three attempts to correctly answer the security questions, after that, they are locked out and must contact the QIES Help Desk to reset their account, 800-339-9313.  

To avoid getting locked out be sure to log into CASPER or the QIES User Maintenance application at least once every 90 days.

Quality Measures/Quality Improvement Information

October, 2012, a new version of the MDS 3.0 Quality Measure User's Manual has been posted under the Downloads are of the CMS MDS 3.0 Technical Information web page (exit DHS) 

Beginning April 1, 2012, the new MDS 3.0 QM data will be available in CASPER under the MDS 3.0 QM Reports report category.

Section 11 of the CASPER Reporting Users Manual provides provides information for how to generate the MDS 3.0 QM reports.  This manual is available on the CMS MDS 3.0 System Welcome page. 

Medicare Nursing Home Compare (exit DHS)

CMS Five Star Rating System information (exit DHS)

CMS Nursing Home Quality Initiatives (exit DHS)

Advancing Excellence in America's Nursing Homes (exit DHS)

Metastar - Wisconsin's Quality Improvement Organization

Medicare Payment Information

CMS Clarification document to the March 2012 Provider Conference, previous clarification documents, provider call transcriptions, and additional information is available under the Downloads area of the CMS SNF PPS RUG IV Education and Training (exit DHS) web page.

CMS SNF PPS (exit DHS)

CMS FY 2012 RUG-IV Education and Training (exit DHS)

Medicare Benefit Policy Manual (exit DHS)

Medicare Claims Processing Manual (exit DHS)

National Government Services (exit DHS)- Medicare claims 

Medicaid Payment Information

MDS 3.0 Section Z items Z0200 and Z0250 are not required to be coded and may be left blank.

Effective October 1, 2010, nursing home providers will begin using the MDS 3.0/RUGS IV-48 classification system for Medicaid residents. The new system does not affect Medicaid Fee for Service billing or rates in the current rate period of July 1, 2010 - June 30, 2011.  The first picture date that will reflect this change will be December 31, 2010, and the first fee for service rates based on RUGS IV-48 will be July 1, 2011. 

Additional Wisconsin Medicaid Payment information:

• Refer to Wisconsin Nursing Home Medicaid Information (PDF, 28.5 KB) for information on case mix and "picture dates"
• RUG IV - 48 Grouper Decision Tree (PDF, 284 KB)
• CMIs are also identified in the RUGIV_Grouperspecs spreadsheet (Excel, 28.5 KB)

Wisconsin Clinical Resource Center

The Wisconsin Clinical Resource Center (WCRC) project is jointly sponsored by the Department of Health Services, LeadingAge Wisconsin and the Wisconsin Health Care Association (WHCA/WiCAL), through funding from the Wisconsin Department of Health Services. Development support is provided by staff from the Center for Health Systems Research & Analysis (CHSRA), University of Wisconsin-Madison. The WCRC website was designed as a user-friendly resource to provide key information to staff working in Wisconsin nursing homes about selected care areas and training topics.

REGISTER now for Individual Log-ins!! Current log-in procedures are changing to allow individual nursing home staff to access the website. Previous facility passwords will no longer be available after October 15, 2012, so spread the word about these changes! Here is all the information you need to know to ensure that you and your nursing home continue to have access to the WCRC resources:

STEP 1: Go to the WCRC Website Address: https://wcrc.chsra.wisc.edu (exit DHS)

STEP 2: Click the link that says “Register”.

STEP 3: Follow the prompts to sign up for an individual logon.

For more information - contact your nursing home association, WCRC email: wcrc@chsra.wisc.edu, WCRC Helpdesk: 888-300-8098.

Additional CMS Resources

SNF/Long Term Care Open Door Forum (exit DHS)

CMS Quality Assurance & Improvement (QAPI) (exit DHS)

CMS SNF Consolidated Billing (exit DHS)

Nursing Home Certification and Compliance (exit DHS)

State Operations Manual - Appendix PP Guidance to Surveyors for Long Term Care Facilities (exit DHS)

State Operations Manual - Appendix P Survey Protocol for LTC Facilities (exit DHS)

CMS Form 672 Resident Census and Conditions of Residents (exit DHS)

CMS Form 802 Roster/Sample Matrix (exit DHS)

CMS Form 802 Provider Instructions (exit DHS)

CMS Forms Website (exit DHS)

Medicare Learning Network (exit DHS)

Nursing Home Value Based Purchasing (exit DHS)

CMS Medicare (exit DHS)

CMS Nursing Home Quality Assurance & Performance Improvement (exit DHS)

Related Resources

DQA E-Mail Subscription Service (Listserv)

DQA Contacts

For questions on the RAI, coding MDS items, or clinically related contact:

Margaret Katz, RN, RAI Education Coordinator
(715) 836-6748

For questions related to submitting MDS records to the CMS/State MDS System, interrupting Validation reports, and accessing CASPER to obtain QI/QM reports and other MDS related reports contact:

Chris Benesh, MDS Automation Coordinator
(608) 266-1718

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Last Updated: June 11, 2013