The Centers for Medicare and Medicaid Services' (CMS) tool for facilitating care management in nursing homes is called the Minimum Data Set (MDS), a core set of screening and assessment elements that is part of a Resident Assessment Instrument (RAI). The RAI provides a comprehensive and standardized assessment of each long-term care facility resident's functional capabilities and helps staff to identify health problems. This assessment is performed on every resident in a Medicare and/or Medicaid-certified long-term care facility.
MDS 2.0 to 3.0
Minimum Data Set, version two was replaced in 2010 with version three. The big difference is that this assessment incorporates direct resident interviews in the process. According to CMS, "MDS was improved to include the resident in the assessment process and to use standard protocols used in other settings."
The daily rate paid to nursing homes is determined through the Medicare Prospective Payment System (PPS), which determines rates based on certain characteristics and the amount of resources used by residents. The grouping system is called RUG (Resource Utilization Group). When MDS 3.0 was introduced so was RUG-IV.
Top Level Differences
Data Submission Changes
- Assessments are submitted to the national system instead of state systems.
- The submission time from assessment completion to assessment submission has been condensed considerably, two weeks sooner.
- The process for correcting errors has been simplified.
- Anticoagulants and Antibiotics were added to the list of medication categories.
CMS has made several changes in how data is collected that affects payment for therapy.
- Data is reported in two columns: care received in the hospital before admission and care received while a resident. Items received in the hospital would be used for care planning and not payment.
- Therapy minutes are entered by how they are administered - individually, to two residents at the same time and in a group setting and do not include the initial evaluation.
- One of the major goals of MDS 3.0 is to increase resident interview items. Appendix D of the MDS 3.0 Manual, "Interviewing to Increase Resident Voice in MDS Assessments," contains approaches to use to make interviews simple and more effective.
Mood and Depression
- MDS 3.0 uses the PHQ-9ÃÂÃÂ©, Patient Health Questionnaire, a checklist of nine symptoms of depression that is completed as a resident interview.
- Most of the questions in the Customary Routine and Activity Pursuit were dropped in favor of a resident interview that may be completed by a family member or significant other.
- Falls are a serious problem in nursing homes. Included in MDS 3.0 is a Fall History on Admission assessment that goes back six months prior to admission.
- Balance and gait items that relate to fall risk were also added.
- To meet payment criteria, a physician-documented diagnosis within the last 60 days is required. There are some exceptions.
- Then it must be determined that the diagnosis is active looking back 7 days.
- The list of diagnoses include more information so they are classified correctly.
- A Swallowing Disorder item was added to help staff detect problems that might be addressed with therapy or through diet.
- A staff examination of the mouth was added at the urging of the American Dental Association.
This only scratches the surface of MDS 3.0 but points to the complexity and the regulations involved in delivering care in a nursing home. This information is not intended and should not be construed as legal advice. But it can start you on the path of understanding.