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 Item Sets and Data Submission Specifications can be downloaded from the CMS MDS 3.0 Technical Information webpage.
The MDS 3.0 RAI User's Manual Version 1.18.11 (PDF) and final MDS 3.0 Item Sets version v1.18.11 v5 (ZIP) are now available. The MDS Item Sets v1.18.11 will be effective beginning October 1, 2023. See the CMS MDS 3.0 RAI Manual webpage for more information.
Wisconsin RAI/MDS items
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.
- 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 TBD.
Past forums and trainings
- September 13, 2023
- June 21, 2023
- Agenda (PDF)
- Slide Presentation (PDF)
Question: If a resident sleeps in a recliner, how would we code bed mobility?
Answer: If the resident doesn't sleep in a bed, clinicians should assess bed mobility activities using the alternative furniture on which the resident sleeps (for example a recliner).
Question: If a resident was living at home, went to the ER, and then was admitted to the NF, how would we code A1805 Entered From? Would it be home or hospital?
Answer: Page A-36 of the RAI draft manual indicates to best describe the setting the resident was in immediately prior to facility admission/entry or reentry. So in this example, hospital would be the correct code.
- March 15, 2023
- February 1, 2023
- October 25, 2022
- August 31, 2022
- June 28, 2022
- CMS MDS 3.0 Training
- CMS Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Training provides links to trainings such as:
- Cognitive and mood assessment
- Achieving a full annual payment update
- Section J
- Section N
- Section GG
- DHS Nursing Home Pressure Injury Information
View information from CMS with timely updates on MDS and related topics.
- Wage Index Tables for FY 2024-Final (ZIP)
- PDPM Case-Mix Adj. Federal Rates (ZIP)
- MDS Data Sets 1.18.11 v5 (ZIP)
- MDS 3.0 Data Specs v3.01.1 (ZIP)
- FY24 Program Year Fact Sheet SNF VBP (PDF)
- FY24 PDPM ICD-10 Mapping (ZIP)
- SNF VBP Performance Score Report User Guide FY24 (PDF)
- HCPCS Codes for SNF CB October 2023 (PDF)
- SDOH Explainer Video
- FY23 State Performance Standards System (SPSS) Guidance (PDF)
- SNF VBP FY24 Program Year Incentive Payment Multiplier Calculation (PDF)
- SNF QRP FY25 Annual Payment Update (APU) Determination (PDF)
- MDS 3.0 Frequency Report Website
- Errata V3.01.2 for MDs 3.0-V3.01.1 (PDF)
- MDS RAI Manual Changes from Draft (PDF)
- RAI Manual V1.18.11 Final (PDF)
- MDS Frequently Asked Questions for Providers V1.2 (PDF)
- Five-Star State-Level Health Inspection Cut Point Table – August 2023 (PDF)
- PDPM ICD Codes FY24 (ZIP)
- Updated Final MDS 3.0 Item Sets version 1.18.11
- 2024 ICD-10-CM
- NH Five-Star Quality Rating System: Technical User's Guide July 2023 (PDF)
- BIMS Tutorial Video
- CMS-1779-F – PPS and Updates to the QRP and VBP FY 2024 (PDF)
- HCPCS Codes Used for SNF CB Enforcement (PDF)
- COVID-19 Vaccine Requirements for LTC Facilities (PDF)
- IQIES MDS Frequently Asked Questions for Providers (PDF)
- SNF 5-Claim Probe and Educate Review and MLN Article
- Pub 100-20 One-Time Notification (PDF)
- NH Level of Care No. 2023-17 (PDF)
- Clinical Resource Center
- CMS SNF 2023 Guidance Training Program
- Revision History for LTC Survey Process Documents and Files (PDF)
- Survey Resources (ZIP)
- July Quarterly Update to HCPCS Codes for SNF CB Enforcement (PDF)
- HCP Influenza Vaccination Summary (PDF)
- Pub 100-04 Medicare Claims Processing (PDF)
- Checking Medicare Claim Status (PDF)
- How to Use the PFS Look-Up Tool (PDF)
- ABN Update(s)
- Guidance and Survey Process for Reviewing Home Dialysis Services in NH (PDF)
- MDS 3.0 CAT Specifications 1.06 (ZIP)
- PEPPER Eleventh Edition (PDF)
- COVID-19 Vaccine, Draft Measure Specs (PDF)
- Discharge Function Score Technical Report (PDF)
- CoreQ SS Discharge Survey Draft Version 1.0 (PDF)
- CMS MDS 3.0 Vendor Call Questions and Answers (PDF) and CMS MDS 3.0 Vendor Call Minutes (PDF)
- Upload an Assessment iQIES (PDF)
- Reports User Manual V2.3 (PDF)
- MDS Error Message User Guide V1.0 (PDF)
- LTC CMS Flexibilities to Fight COVID-19 (PDF)
- SNF VBP Program FAQs (PDF)
- CDC NHSN Annual Facility Survey Review (PDF)
- Kepro Case Review Connections
- Discharge Function Score for SNFs (PDF)
- MDS QM User's Manual V15 Update (ZIP)
- Five Star Quality Rating System State-Level Cut Point Tables (PDF)
- 2023 POA Exempt Codes (ZIP)
- Full Text of Statements of Deficiencies (ZIP)
- 2023 Pain Interview Cue Cards (PDF)
- 2023 PHQ-2 to 9 Cue Cards (PDF)
- 2023 BIMS Cue Cards (PDF)
- Transfer of Health Items Explainer Video
- GG0170C Lying to Sitting on the Side of Bed
- GG0170L Walking 10 Feet on Uneven Surfaces
- GG0170P Picking Up Object
- Sample iQIES MDS 3.0 Reports newsletter and downloadable sample reports (ZIP)
- Operational Guidance to Report Annual Influenza Vaccine to NHSN (PDF)
- Medicare Payment Systems
- 2023 Conversion Table (ZIP)
- CMS Waivers (PDF)
- MDS 3.0 Data Specs (V3.01.0) Draft (ZIP)
- MAC Contact Info (Excel)
- ICD-10 & Other Coding: July 2023 Update (PDF)
- HCPCS Codes Used for CB: April 2023 Update (PDF)
- NH Compare Five-Star Quality Rating System: Technical Users' Guide (PDF)
- ICD-10-CM Official Guidelines for Coding and Reporting (PDF)
- ICD-10-CM April 1, 2023, Update with NCHS
- SNF QRP Covid-19 Public Reporting Tip Sheet 3rd Edition (PDF)
- Covid-19 Vaccine: Percent of Residents Who Are Up to Date Draft (PDF)
- Nursing Homes all Datasets (ZIP)
- Care Compare Nursing Home Five-Star Quality Rating System (PDF)
- Updates to Chapter 10 of Pub. 100-08 (PDF)
- Payroll Based Journal Daily Nurse Staffing
- Expanded Coverage for Permanent Telehealth Policy (PDF)
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 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.
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.
- Software (jRaven)
- Reference & Manuals
- Access Forms
- Important Links
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.
- The MDS 3.0 Quality Measure User's Manual is under Downloads on the CMS Quality Measures website.
- The iQIES Reports User Manual (PDF) provides information for how to generate the MDS 3.0 Quality Measures reports.
- Medicare Nursing Home Compare
- CMS Five Star Rating System
- CMS Nursing Home Quality Initiative
- Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Measures and Technical Information
- CMS Nursing Home Quality Assurance & Performance Improvement (QAPI)
- Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Public Reporting includes information for Provider Preview Reports
- CMS SNF PPS
- Patient Driven Payment Model
- Medicare Benefit Policy Manual Chapter 8 (PDF)
- Medicare Claims Processing Manual Chapter 6 (PDF)
- National Government Services - Medicare claims
- Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program
- 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.
Based on customer and provider feedback, a new process for referring residents to an Aging and Disability Resource Center (ADRC) was implemented effective December 2022. Detailed information and training resources are provided below.
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.
- 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.
- Skilled Nursing Facility Center
- SNF/Long Term Care Open Door Forum
- CMS SNF Consolidated Billing
- Nursing Home Certification and Compliance
- State Operations Manual (SOM) and SOM Appendix (PDF)
- CMS Form 672 Resident Census and Conditions of Residents (PDF)
- CMS Policy & Memos to States and Regions
- CMS Staffing Data Submission PBJ (QTSO Reference & Manuals webpage)
- Medicare Learning Network
- Form 20132 which is located in the "Survey Resources" ZIP folder on the CMS Nursing Homes webpage
CMS Nursing Homes webpage includes links to the critical element pathways, CMS-802, and other valuable resources.
- DQA Email Subscription Service (Listserv)
- The Wisconsin Health Care Association (WHCA) / Wisconsin Center for Assisted Living (WiCAL) is a non-profit organization dedicated to representing, protecting, and advancing the interests of Wisconsin's long-term care provider community and the residents they serve.
- Metastar - Wisconsin's Quality Improvement Organization
- Clinical Resource Center
For questions about the RAI, coding MDS items, or clinically related information contact Heather Newton, RAI education coordinator:
- Email firstname.lastname@example.org.
- Call 920-360-6102.
For technical or automation questions about submitting MDS records, interpreting validation report messages, and generating CASPER reports, contact Emily Virnig, MDS automation coordinator:
- Email email@example.com.
- Call 608-266-1718.