RAI Manual v1.13 Released: Changes Effective Oct 1st

Karen Morris in Clinical & Quality

AHCA has shared the following news article related to the release of the MDS 3.0 RAI User’s Manual v1.13. Also included are the links to the manual posted on the CMS website.

Breaking News: CMS Releases v1.13 of the RAI User's Manual
by Lisa Hohlbein, RAC-MT, CDP, CADDCT | Sep 15, 2015

It’s here! The Centers for Medicare & Medicaid Services (CMS) has released the MDS 3.0 RAI User’s Manual v1.13. This release includes the full manual, replacement pages, and change tables for both. The change tables do not include corrections to minor formatting, punctuation, or typographical errors as in past releases. As a general note, there are many changes related to clarity, updated URLs, title size, and page length in this update.

As expected, the biggest change in the manual concerns the new ICD-10 coding system for diagnosis, mostly affecting section I of the MDS. However, CMS made a number of clarifications throughout the manual where guidance may have been confusing in the past. Here are some of the notable clarifications:

  • Chapter 2, p. 2-4: Newly Certified Nursing Homes
    • The completion and submission for OBRA and/or PPS assessments is a requirement for Medicare and/or Medicaid long-term care nursing homes. When a nursing facility is in the process of certification, OBRA and/or PPS assessments are still required to demonstrate compliance with certification requirements. Since these assessments have assessment reference dates (ARDs) prior to the certification date, CMS does not have the authority to receive them into QIES ASAP, and so they should not be submitted to the QIES ASAP system.
    • If facility staff completes an Admission assessment prior to the certification date, there is no need to do another Admission assessment after 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.
    • Medicare cannot be billed for any care provided prior to the certification date. Therefore, the nursing home must use the certification date as day one of the covered Part A stay when establishing the ARD for the Medicare Part A SNF PPS assessments.
  • Chapter 2, p. 2-52: COT 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, p. A-32 (A2400): CMS has stricken the words “Generic Notice” and replaced them with “Notice of Medicare Non-Coverage (NOMNC)” both in the item itself and in the subsequent example.
  • Chapter 3, p. I-4:
    • When a resident receives aftercare following a hospitalization, a V code is currently assigned in section I. Beginning October 1, 2015, aftercare codes will begin with a Z.
      • When Z codes are used, another diagnosis for the related primary medical condition should be checked in items I0100–I7900 or entered in I8000.
  • 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, code 0. Since the language changed here, CMS deleted two coding tips in M0300A, for clarity. They are:
    • 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.
  • Chapter 6, p. 6-2: The Medicare Short Stay Algorithm has been updated. All references to the Readmission/Return assessment have been removed.
  • https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html
  • MDS 3.0 RAI Manual v1.13 and Change Tables October 2015 [ZIP, 22MB]
  • MDS 3.0 RAI Manual v1.13 Replacement Manual Pages and Change Tables October 2015 [ZIP, 1MB]
  • MDS Item Sets, effective 10/1/15:
  • https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS-3-0-Item-subsets-V1-13-2-for-the-October-1-2015-Release.zip

Holly Harmon, RN, MBA, LNHA
Senior Director of Clinical Services
American Health Care Association
1201 L Street NW
Washington, DC 20005


Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15