RAI/MDS 3.0 Information

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

  • MDS Automation Coordinator
    608-266-1718
    For technical/automation questions related to submitting MDS records, interpreting validation report messages, and generating CASPER reports.
  • RAI Education Coordinator
    920-360-6102
    For questions on the RAI, coding MDS items, or clinically related.

CMS RAI/MDS Items

Wisconsin RAI/MDS Items

  • Preadmission Screening and Resident Review (PASRR)
  • MDS 3.0 Section Q Automated Referral Process is described in the accordion below
  • 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).

Provider Education

RAI/MDS Educational Forum

The Division of Quality Assurance (DQA) sponsors a quarterly educational forum to assist in keeping nursing homes updated with evolving RAI/MDS information and to provide an avenue for nursing home staff to ask RAI/MDS-related questions. The forum is hosted jointly by DQA's RAI/MDS Education and Automation Coordinators.

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: 161-306-5344
    • Passcode: 551756
  • Join by Phone: 551-285-1373
    • Enter 1613065344 # when asked for the meeting ID
    • Enter 551756 # if asked for passcode
    • Enter # if asked for participant ID
Previous Forums

  • March 16, 2022, recording - Agenda (PDF) and Slide Presentation (PDF)

    The Top Participants in this quarter's forum activity were Nicole, Rene, and American Data. Thank you for playing!

  • December 15, 2021, recording - Agenda (PDF) and Slide Presentation (PDF)

  • October 21, 2021, recording - Agenda (PDF) and Slide Presentation (PDF)

    Additional clarification:
    • The sections that will need to be completed to generate a PDPM on standalone NC and NQ assessments are:
      • GG0130, column 1 only;
      • GG0170, column 1 only;
      • I0020B;
      • J2100; and
      • J2300–J5000 (If J2100 = 1)

    • The look back period for the specific sections of GG for the standalone OBRA NC and NQ would be the ARD and the two previous days.

      Example: ARD is 10/7/2020. The look back period for section GG would be 10/5, 10/6, and 10/7.

    • The look back periods for the specific sections of I and J have not changed.
    A special thanks to everyone who participated in the Poll Everywhere game!
    • Christina and Amy Jo tied with 18 points!
    • Lisa, Katie, and Jacquie tied with 17 points!
    • Amber, Chris, Heidi B, John, and Kim tied with 16 points!

  • July 7, 2021, recording - Agenda (PDF) and Slide Presentation (PDF)

    A special thanks to everyone who participated in the Jeopardy game!
    • Miranda - 5400
    • MD - 2800
    • Dina - 2600
Training

Technical Resources

Only OBRA and Medicare 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 QIES ASAP system. Additional information related to Transmitting MDS Data is identified in Chapter 5 of the MDS 3.0 RAI Manual (PDF).

Assessments that are completed for purposes other than OBRA and SNF PPS reasons (such as private insurance, including but not limited to Medicare Advantage plans) are not to be submitted.

Test data should not be submitted to the QIES ASAP system. Please review 5.8 Special Manual Record Correction Request 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

Providers, vendors, state agency and regional office personnel, and other organizations performing Survey & Certification functions will find technical guidance such as references & manuals, software tools, and training materials on the QTSO website.

CMS User Account Registration

QTSO is moving towards 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 an otherwise secure connection has been established. Account registration instructions are located 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.

Quality Improvement

Payment Information

Medicare Payment Information

Medicaid Payment Information

MDS 3.0 Section Q Automated Referral Process

Effective October 4, 2021, nursing homes will no longer need to use the Program Participation System (PPS) to enter MDS Section-Q referral information. Referrals will now automatically generate when a nursing home completes MDS Section-Q and enters the information into their MDS system, eliminating the need for nursing homes to enter MDS Section-Q referral information into a separate system. The recently completed MDS-Q Referral System will automatically notify the Aging and Disability Resource Center (ADRC) serving the county where the nursing home is located when they have a referral.

If a resident indicates they would like to discharge outside of their MDS window, referrals should be handled by contacting the ADRC serving the county where the nursing home is located by phone or email in a timely manner. The ADRC will then manually enter the referral into their system and follow up as necessary with the customer and the nursing home.

Summary of the new process:
  • A thorough description of the process can be found in the ADRC Operations Manual, P-03062, specifically the MDS-Q and Nursing Home Transitions, P-03062-02A (PDF) section, including how to handle non-MDS referrals.
  • MDS Referral
    • The nursing home completes the MDS assessment and enters the data into their MDS system.
    • MDS data is sent to and processed by CMS.
    • Wisconsin receives the MDS data and analyzes the data for MDS-Q referral criteria.
    • If the MDS-Q information indicates that the ADRC should receive the referral, the data is automatically sent to the ADRC in the county in which the nursing home is located.
    • Once every business day, ADRCs with a new MDS-Q referral will receive an automated email to their designated MDS-Q email address.
    • The implementation of the new ADRC MDS-Q Referral System only changes the method of referral retrieval.
  • Non-MDS Referral
    • The nursing home contacts the ADRC serving the county where the nursing home is located by phone or email in a timely manner.
    • The ADRC will manually enter the referral into their system.
  • The remaining steps of the referral process have not changed. The ADRC will follow up as necessary with the customer and the nursing home.
  • The ADRC will document the referral outcomes.
Additional resources:

Additional CMS Resources

Additional Resources

Last Revised: May 13, 2022