CMS Posts Updated MDS Manual v1.13

The Centers for Medicare & Medicaid Services (CMS) have released the Minimum Data Set/Resident Assessment Instrument manual - MDS 3.0 RAI User’s Manual v1.13.  The manual is available electronically at no cost on the CMS MDS website.  The release of the documents includes the updated MDS 3.0 RAI manual, change tables, and replacement pages for the printed version. There are minimal changes of significance.  Most of the changes are cosmetic in nature providing more clarity, updated weblink addresses, and document formatting changes.  

The most significant change is related to the new ICD-10 (International Statistical Classification of Diseases and Related Health Problems  - 10th revision) coding system for diagnosis coding in Section I.

Some of the notable clarifications related to the MDS process are as follows:

• Chapter 2: Newly Certified Nursing Homes
  • When a nursing facility is in the process of certification, MDS assessments are still required to demonstrate compliance with certification requirements but should not be submitted to the QIES ASAP system if the ARD is prior to the certification date.
  • Assessments completed would not need to be redone following certification.  The nursing home will simply continue with the next expected OBRA and/or PPS assessment even though there may be a sequencing error on the validation report.
  • For Medicare claims, the certification date would serve as day one of the covered Part A stay when establishing the ARD for the Medicare Part A SNF PPS assessments.
• Chapter 2: Change of Therapy (COT) Other Medicare Required Assessment (OMRA)
  • In cases where the last day of the Medicare Part A benefit (the date used to code A2400C on the MDS) is prior to day seven of the COT observation period, then no COT OMRA is required. If the date listed in A2400C is on or after day seven of the COT observation period, then a COT OMRA would be required if all other conditions are met.
  • In cases where the date used to code A2400C is equal to the date used to code A2000—that is, cases where the discharge from Medicare Part A is the same day as the discharge from the nursing home—and this date is on or prior to day seven of the COT observation period, then no COT OMRA is required. However, the COT OMRA may be combined with the Discharge assessment if that is preferred.
• Chapter 3: CMS has stricken the words “Generic Notice” and replaced them with “Notice of Medicare Non-Coverage (NOMNC)” in item A2400.
• Chapter 3, p. M-5 (M0210): If a resident had a pressure ulcer that healed during the look-back period of the current assessment but there was no documented pressure ulcer on the prior assessment, it will be coded as "0". To clarify this the following language is available:
  • "If a resident had a pressure ulcer on the last assessment and it is now healed, complete Healed Pressure Ulcers item (M0900)."
  • "If a pressure ulcer healed during the look-back period, and was not present on prior assessment, code 0."

All in all, this update does not represent any change to current MDS practice that would significantly impact reimbursement.

Contact:  Michelle Synakowski, msynakowski@leadingageny.org, 518-728-8850.