PDPM HIPPS code on OBRA assessments
- Effective October 1, 2020, Wisconsin will require the submission of PDPM HIPPS codes on OBRA MDS comprehensive and quarterly assessments.
- Nursing homes should contact their MDS software vendors about this change.
This 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 webpage will exit the Wisconsin Department of Health Services (DHS) website.
Wisconsin RAI/MDS Contacts
Vacant, MDS Automation Coordinator
- For technical/automation questions related to submitting MDS records, interpreting validation report messages, and generating CASPER reports.
Heather Newton, RAI Education Coordinator
- For questions on the RAI, coding MDS items, or clinically related.
This information is grouped under the following categories:
- RAI/MDS Items
- Section Q
- Section S
- Provider Educational Opportunities
- Technical Resources
- Quality Measures/Quality Improvement Information
- Payment Information – Medicare & Medicaid
- Additional CMS Resources
- Related Resources
- Wisconsin Clinical Resource Center
- The MDS 3.0 RAI Manual is available under the Related Links area of the CMS MDS 3.0 RAI Manual website.
- The MDS Item Sets and Data Submission Specifications are available for download from the CMS MDS 3.0 Technical Information website.
- MDS 3.0 Section Q Referral Automated Process Information/Instructions
- CMS Section Q resources/information
State Optional Items and Section S
- Wisconsin does not have a Section S for MDS 3.0 and 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
DQA sponsors a quarterly educational forum to assist in keeping nursing homes with evolving RAI/MDS information and to provide an avenue for nursing home staff to ask RAI/MDS-related questions. The RAI/MDS Educational Forum will be hosted jointly by DQA’s RAI/MDS Education and Automation Coordinators.
Next RAI/MDS Educational Forum: January 20, 2021, 1-2 pm
To attend the RAI/MDS Educational Forum:
- Join Zoom forum (select this link to go straight to the room without needing to enter the meeting ID and password)
- Meeting ID: 942-2027-1641
- Or by Phone: 312-626-6799
- Enter 942-2027-1641# when asked for the meeting ID
- Enter # if asked for participant ID
Recordings and Agendas of Previous Forums:
- January 20, 2021, recording - Agenda (PDF) Slide Presentation (PDF)
- October 28, 2020, recording - Agenda (PDF) Slide Presentation (PDF)
- July 29, 2020, recording – Agenda (PDF) Slide Presentation (PDF)
Section GG Training
Video Tutorials Available to Assist with Coding Specific Section GG Items
March 20, 2020 – New video tutorials available to assist with coding of specific MDS Section GG items. These videos can be accessed on the CMS SNF Quality Reporting Program Training webpage.
CMS released a series of short videos to assist providers with coding select Section GG items on the OASIS, IRF-PAI, LTCH CARE data set, and the MDS. These videos, ranging from 4-12 minutes, are designed to provide targeted guidance using simulated patient scenarios. To access the videos, select the links below:
- Coding GG0110. Prior Device Use with Information From Multiple Sources (3:58)
- Decision Tree for Coding Section GG0130. Self-Care and GG0170. Mobility (11:56)
- Coding GG0130B. Oral Hygiene (4:25)
- Coding GG0170C. Lying to Sitting on side of bed (4:33)
MDS Section GG was implemented October 1, 2016. CMS developed the following YouTube four part Section GG training:
CMS developed MDS 3.0 Provider Training videos for Sections I, G, M and O. These YouTube videos and additional MDS 3.0 training videos can be accessed on the CMS MDS 3.0 Training webpage.
SNF Quality Reporting Program training materials.
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
CMS made changes to the MDS Correction Policy effective May 19, 2013. Changes include the ability to submit a modification to correct typographical and data entry errors for A0310: Type of Assessment (if there is no Item Set Code change) and A2300: Assessment Reference Date (if results do not change look back period). Refer to Chapter 5 of the most recent version of the RAI Manual for additional information. The RAI Manual can be downloaded from CMS MDS 3.0 RAI Manual website.
CMS PowerPoint slides identifying changes to MDS 3.0 Manual Modification/Inactivation policy, effective May 19, 2013.
Submission Information and User's Guide
The MDS 3.0 Provider User's Guide is available on the QTSO Nursing Home/Swing Bed Providers – Reference and Manuals webpage. 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 3.0 Provider User's Guide. There is also an Appendix A-Quick Reference.
User IDs/Passwords Required
Requesting access to CMS systems requires two steps to obtain two separate login IDs. A CMSNet User ID and a QIES Submission/MDS Individual login ID.
Use the CMSNet Online Registration application to request a CMSNet User ID.
The CMSNet ID is needed to access secure CMS sites (for example, submissions pages/reports) unless an otherwise secure connection has been established.
Use the QIES online User Registration tool to obtain a QIES Submission ID. Once you have registered for a CMSNet User ID, you will receive an email from MDCN.firstname.lastname@example.org containing your login information. Using this information you will connect through the "CMS Secure Access Service."
Once securely connected, select the "CMS QIES Systems for Providers" link to access the QIES online "User Registration" tool. New users must utilize the online "User Registration" tool to obtain a QIES Submission/MDS Individual login ID (the only exception is corporate/third-party accounts).
Additional information is available on the QTSO MDS Access Information webpage.
QIES Submission/MDS Individual ID Requirements
A user selects their own QIES login password when they register for their individually assigned login account. The password must meet stringent password rules that are available to view on the password webpage. 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:
- On the CMS MDS Welcome page select the QIES User Maintenance link.
- Select "Forgot your password or Inactive Account?"
- 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.
- The MDS 3.0 Quality Measure User's Manual is available under the Downloads area of the CMS Quality Measures website.
- 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 QTSO Nursing Home Reference & Manuals website.
- CMS MDS 3.0 QM User's Manual – available under the Downloads area
- Medicare Nursing Home Compare
- CMS Five Star Rating System information
- CMS Nursing Home Quality Initiatives
- CMS SNF Quality Reporting Program (QRP) – including information on Review and Correct Reports
- Metastar - Wisconsin's Quality Improvement Organization
- CMS Nursing Home Quality Assurance & Performance Improvement (QAPI)
Medicare Payment Information
- CMS SNF PPS
- Patient Driven Payment Model
- Medicare Benefit Policy Manual
- Medicare Claims Processing Manual
- National Government Services - Medicare claims
- Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program
Medicaid Payment Information
- MDS 3.0 Section Z items Z0200 and Z0250 are not required to be coded and may be left blank.
- Wisconsin Medicaid uses the MDS 3.0/RUGS IV-48 classification system for Medicaid residents.
- Additional Wisconsin Medicaid Payment information:
- Forward Health Update 2017-31 Nursing Home Level of Care Process Change and New Level of Care Report (PDF)
- ForwardHealth Update 2017-04 New Policy Regarding Developmentally Disabled Level of Care Assignments (PDF)
Additional CMS Resources
- Federal Register – Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities (published 10/4/16)
- Skilled Nursing Facility Center
- SNF/Long Term Care Open Door Forum
- CMS SNF Consolidated Billing
- Nursing Home Certification and Compliance
- State Operations Manual - Appendix PP Guidance to Surveyors for Long Term Care Facilities
- State Operations Manual - Appendix P Survey Protocol for LTC Facilities
- CMS Form 672 Resident Census and Conditions of Residents
- CMS Certification & Survey (S&C) Memos
- CMS Staffing Data Submission PBJ additional information on QTSO Reference & Manuals webpage
- Removal of SSNs from Medicare Cards
- Medicare Learning Network
- CMS Medicare
- Preadmission Screening and Resident Review (PASRR)
- Nursing Home Pressure Ulcer Information
- DQA Email Subscription Service (Listserv)
Clinical Resource Center
The Clinical Resource Center (CRC) project is jointly sponsored by the Wisconsin Department of Health Services, LeadingAge Wisconsin and the Wisconsin Health Care Association (WHCA/WiCAL), through funding from the Department of Health Services. Development support is provided by staff from the Center for Health Systems Research & Analysis (CHSRA), University of Wisconsin-Madison. The CRC 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.
CRC Website Address: https://crc.chsra.wisc.edu/
For more information:
- Contact your nursing home association
- CRC email: email@example.com
- CRC Helpdesk: 888-300-8098