September 26, 2013_NH "Dear Administrator"

September 26, 2013

ALTSA:  NH #2013-018

Dear Nursing Facility/Home Administrator:

This letter contains important information for facility staff responsible for completing the Minimum Data Set (MDS) assessments.

The Centers for Medicare and Medicaid Services (CMS) recently released the updates to the Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual Version 3.0. Changes include updates and clarifications, some of which are minor "clean ups" such as correcting spelling, the addition of new items and some substantive changes as well.  Changes have occurred in Sections G, H, K, M, O, Q and Z of Chapter 3.  Portions of Chapters 1, 2, 6, and Appendices have edits. The updates are effective October 1, 2013.

The update includes "Track Changes" documents that describe the items in each chapter/section that have changed and the page number of the changes and the actual chapter/sections that have been changed.  You may choose to download the entire chapters or only the pages where changes have occurred: 

  • Chapter 1, Page 16-18 Updated the Privacy Act Statement
  • Chapter 2: Discharge assessment, the ARD (Item A2300) is not set prospectively as with other assessments. The ARD (Item A2300) for a Discharge assessment is always equal the Discharge date (Item A2000) and may be coded on the assessment any time during the Discharge assessment completion period (i.e., discharge date (A2000) + 14 calendar days).
  • Clarifications to unscheduled PPS assessments (OMRAs)
  • Section G has a number of significant changes. Clinical staff must first observe what the resident is able to do without assistance, and then determine the level of assistance the resident requires from staff.
  • Section G-0110, Page G-9 ADL Self-Performance Algorithm – New instructions to "Remember to review the instructions for the Rule of 3 and the ADL Self-Performance Coding Level Definitions before using the algorithm. STOP at the first code that applies when moving down the algorithm".
  • Section G-0110 ADL Assistance- new Scenario and Rationale examples.
  • Section H0300 – Urinary Continence definition changed: Any void that occurs voluntarily, or as the result of prompted toileting, assisted toileting, or scheduled toileting
  • Section K0510, Food elimination diets related to food allergies (e.g. peanut allergy) can be coded as a therapeutic diet.
  • K0700 has been replaced by K0710
  • Section M, removed non-epithelialized and necrotic wording
  • Section O0400 Co-treatment minutes added and further clarification for therapy start and end dates.
  • O0420; Distinct Calendar Days of Therapy added: If a resident received more than one therapy discipline on a given calendar day, this may only count for one calendar day for purposes of coding.
  • Section Q: Wording clarifications
  • Section Z0400: Attestation signature requirements defined
  • Chapter 6: Changed wording on RUG calculation pages to reflect the changes to Sections K & O
  • Appendix H: New MDS 3.0 Item Set forms- effective date October 2013. Your software vendor should be updating your software to accommodate the changes.

To obtain the RAI Manual changes go to the CMS webpage at:

It is the responsibility of the individuals who complete the MDS to have the most current RAI Manual instructions in order to accurately complete the required assessments.

Residential Care Services (RCS) will be providing 2-day MDS 3.0 Basic seminars in 2014. The seminar schedule will be listed on our website after January 1, 2014: Facilities will need to pre-register the number and names of attendees for each session.

If you have any questions or need further information, please contact Sandy Kerrigan, RN, Washington State RAI Coordinator, at (360) 725-2487 or e-mail at


E. Irene Owens, Interim Director
Residential Care Services