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Upcoming Changes: Center for Medicare & Medicaid Services - MDS 3.0

Attention HealthPRO Heritage partners, we would like to inform you that the Centers for Medicare & Medicaid Services (CMS) has recently released and updated the MDS 3.0 RAI Manual and item sets in draft form. As a result, there have been various changes to multiple sections and guidance.


To ensure your success in implementing these changes, we are pleased to announce that we will be providing an exclusive recording to our partners that covers all of the upcoming changes. Please stay tuned for this recording and consider the strategies we have prepared for each updated MDS section.


  • Section A: Staff must understand the criteria for coding between resident declines to answer vs resident refuses to answer. Note the interview icon for this as well as in other MDS sections. Be aware that when a resident declines to respond, this will be the only coding option for the item.


  • Section B: Train staff on health literacy and assist the resident with reading and interpreting pamphlets. Therapy should support teach back.


  • Section C: Added to Nursing Home End of Medicare Stay Discharge assessment (NPE) – confirm who will conduct the interview. Interrater reliability between clinicians should be considered.


  • Section D: Staff should administer the social isolation question with a collaboration between departments. The team may be stopping the PHQ2-9 interview after question 2, so there is a lesser likelihood of capturing depression now more than before. This could also reduce the workload for SS or other departments who provide the Resident Mood Interview.


  • Section GG: There are several new items, and software updates will be required to support new questions and coding responses. A licensed professional should work with the aides to obtain this information. Education and accountability are important. A huddle on each unit with the nurse managers and aides should be added to report on the functional performance of residents and gather “baseline” data.


  • Section J: New pain items will need to be updated in the software. Work with therapy and other departments to determine pain with sleep, therapy, and daily activity (non-therapy). Review the definition of “therapy” for J0520.


  • Section K: Educate staff on the definition for coding each column. Be aware that on admission, while a resident (7 day lookback), and upon discharge have specific definitions with lookback periods defined.


  • Section N: Confirm drug classes for accuracy and coordinate with the pharmacy. Be proactive and make sure all medications have an indication for use.


  • Section O: Staff should review all of the new details required for this section. On admission, while a resident (14 day lookback), and upon discharge have specific definitions with lookback periods defined. Utilize tracking sheets during clinical meetings to confirm the detailed items are identified in the hospital doc and EMR. All hospital records should be filed timely and attached to resident files in the EMR when possible to reduce liability claims when required to show proof. Additional Development Request documentation collection will be paramount.


  • Section Q: The staff should identify participation in assessment and goal setting with training for updated item choices in this section.


We, at HealthPRO Heritage, understand that the upcoming changes to the MDS may require some adjustment to your current strategies. Our team is committed to providing you with the resources and support you need to succeed. We encourage you to stay informed and keep an eye out for our recorded training, which will be released soon. If you have any questions or concerns, please don't hesitate to reach out to us at teleMDS@healthpro-heritage.com. Thank you for your attention and ongoing commitment to excellence in patient care and your partnership.


Tags: MDS Changes