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 web page will exit the Wisconsin Department of Health Services website.
Wisconsin RAI/MDS Contacts
Chris Benesh, MDS Automation Coordinator
- For technical/automation questions related to submitting MDS records, interrupting validation report messages, and generating CASPER reports.
Margaret Katz, RN, 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 and Change Tables, are available under the Downloads area of the CMS MDS 3.0 RAI Manual website.
The MDS Item Sets/Subsets and Data Submission Specifications are available for download from the CMS MDS 3.0 Technical Information website.
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.
- 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.
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
DQA/DLTC Joint Memo# 12-009 MDS Section Q Referral to Local Contact Agency Process and Automated Submission, issued 06/26/12
CMS Section Q Implementation Questions and Answers (PDF, 168 KB)
CMS Section Q Brochure (PDF, 97 KB)
Connection to Community Living (nursing home relocation initiative)
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.
MDS 3.0 for Beginners - 2015 (PDF, 46 KB) sponsored by the Department of Health Services, Division of Quality Assurance.
CMS has developed new 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 web page.
XML Final Validation Reports
Effective September 20, 2015, CASPER will now include XML versions of Final Validation reports. These reports are in addition to the system-generated final validation reports created in the Text output format. The reports will be automatically stored into each facility’s Validation Report (VR) folder in CASPER. Final Validation reports are automatically deleted after 60 days.
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. 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.
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. 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.
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 (e.g., submissions pages/reports) unless an otherwise secure connection has been established.
CMSNet Online Registration Instructions (PDF, 444 KB)
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 web page.
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 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.
A facility is allowed to have a maximum of two Individual MDS 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 an individual MDS ID for an additional user. To remove an account use the MDS Individual User Account Request form available on the QIES Technical Support Office (QTSO) website at https://www.qtso.com/accessmds.html.
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 MDS 3.0 System Welcome page and is also available on the QTSO MDS 3.0 User Guides and Training website.
CMS MDS 3.0 QM User's Manual - available under the Downloads area
CMS Five Star Rating System information
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 web page.
National Government Services - 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.
Wisconsin Medicaid uses the MDS 3.0/RUGS IV-48 classification system for Medicaid residents.
Additional Wisconsin Medicaid Payment information:
Additional CMS Resources
State Operations Manual - Appendix PP Guidance to Surveyors for Long Term Care Facilities
State Operations Manual - Appendix P Survey Protocol for LTC Facilities
DQA Email Subscription Service (Listserv)
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.
WCRC Website Address: https://crc.chsra.wisc.edu/
For more information:
- Contact your nursing home association
- WCRC email: email@example.com
- WCRC Helpdesk: 888-300-8098.