Nursing homes across the country have been preparing for months to implement Minimum Data Set (MDS) and Resident Assessment Instrument (RAI) changes, which officially went into effect on Sunday, October 1, 2023.
According to the Centers for Medicare & Medicaid Services (CMS), the MDS 3.0 is "a core set of elements, including common definitions and coding categories, which form the foundation of a comprehensive assessment for all residents of nursing homes certified to participate in Medicare or Medicaid. The screening, clinical, and functional status items in the MDS 3.0 standardize communication about resident problems and conditions."
MDS assessors should note critical changes in the following areas of the updated manual:
- Coding instructions related to resident interviews.*
- Pain assessment questions. Effective October 2023, there are no longer "yes" or "no" questions during a pain assessment. See J0300 through J0600 for specifics on how pain assessment coding has changed.)
- Social determinants of health (SDOH) that are not provided by the resident. To maintain best practices, MDS assessors should always document when they received SDOH information elsewhere (from a staff assessment, family member, etc.).
According to an article from McKnight’s Long-Term Care News, many of these changes were expected.
For example, a notable revision is the removal of section G, which covered metrics pertaining to residents’ activities of daily living (ADLs).
Prior to October 2023, Resource Utilization Groups (RUG) scores were derived from section G of the MDS to determine Medicaid reimbursement in select states. With the removal of section G from the MDS, those states will need to consider switching to a Patient Driven Payment Model (PDPM) for reimbursement.
If your senor living organization could use help navigating these clinical reimbursement changes, especially with transitioning to the PDPM reimbursement model, LeaderStat can help. Our expert team of consultants will partner with you to leverage MDS, improve accuracy, and get the revenue you are entitled to deserve.
Want to learn more? Contact us and we’ll set up a quick phone call to discuss a customized plan.
Additional Resources for MDS Coordinators
View the final version of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual Version 1.18.11. MDS Coordinators and Nurse Assessment Coordinators (NACs) should pay special attention to Appendix A of this manual, which includes helpful definitions and acronyms.
MDS 3.0 Technical Information
MDS professionals can see when specific changes were made, up to September 2023. Scroll to the bottom of this Technical Information page on the CMS website to view all available downloads.
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State RAI Coordinator Directory
https://www.cms.gov/files/document/appendix-baugust-2023.pdf
*According to AAPACN, resident interviews are the primary source of MDS assessment data.
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