MDS Item Set Changes

As announced during the September 2 member call, CMS released the draft MDS Item Set that will be effective October 1, 2023. Here are the changes noted in the draft MDS Item set in comparison to the current MDS.  Please note, the RAI manual has not been revised at this time to direct coding the MDS, these changes are the structural changes in the MDS Item Set (draft version). These changes may help guide providers in revising assessments that drive coding in the MDS.  LeadingAge Iowa is working to secure education for members related to MDS changes and will publish opportunities when available.

Section A:

• Removed A0300 – Optional State Assessment.
• Changed A1000 Race/Ethnicity to two sections.A1100 changed to A1110 A is now “What is your preferred language” and A1110B asks “Do you need or want an interpreter to communicate with a doctor or health care staff.
  • A1005 Ethnicity: Are you of Hispanic/Latino(a) or Spanish origin?
    • No,
    • Yes, Mexican, Mexican/American, or Chicano(a)
    • Yes, Puerto Rican
    • Yes, Cuban
    • Yes, another origin
    • Unable to respond
    • Declines to respond
  • A1010 Race:
    • White
    • Black or African American
    • American Indian or Alaskan Native
    • Asian/Indian
    • Chinese
    • Filipino
    • Japanese
    • Korean
    • Vietnamese
    • Other Asian
    • Native Hawaiian
    • Guamanian or Chamorro
    • Samoan
    • Other Pacific Islander
    • Unable to respond
    • Declines to respond
    • None of the above
• A1100 changed to A1110 A is now “What is your preferred language” and A1110B asks “Do you need or want an interpreter to communicate with a doctor or health care staff.
• Added A1250 Transportation.  “Has lack of transportation kept from medical appointments, meetings, work, or from getting things needed for daily living?” (Check all that apply)
  • Yes, it has kept me from medical appointments or from getting my medications.
  • Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need.
  • No
  • Resident unable to respond.
  • Resident declines to respond.
• Changed A1800 to A1805 Entered From (note additional options)
  • Home/Community
  • Nursing Home
  • Skilled Nursing Facility
  • Short-Term General Hospital
  • Long-Term Care Hospital
  • Inpatient Rehabilitation Facility
  • Inpatient Psychiatric Facility
  • Intermediate Care Facility (ICF/ID)
  • Hospice (home/non-institutional)
  • Hospice (institutional facility)
  • Critical Access Hospital
  • Home under care of organized home health service organization
  • Not listed.
• Changed A2100 to A2105 Discharge Status (note additional options)
  • Home/Community
  • Nursing Home
  • Skilled Nursing Facility
  • Short-Term General Hospital
  • Long-Term Care Hospital
  • Inpatient Rehabilitation Facility
  • Inpatient Psychiatric Facility
  • Intermediate Care Facility (ICF/ID)
  • Hospice (home/non-institutional)
  • Hospice (institutional)
  • Critical Access Hospital
  • Home under care of organized home health service organization
  • Deceased
  • Not listed.
• Added A2121 Provision of Current Reconciled Medication List to Subsequent Provider at Discharge. At the time of discharge to another provider, did your facility provide the resident’s current reconciled medication list to the subsequent provider?
  • No
  • Yes
• Added A2122. Route of Current Reconciled Medication List Transmission to Subsequent Provider. Indicate the route(s) of transmission of the current reconciled medication list to the subsequent provider (check all that apply)
  • Electronic Health Record
  • Health Information Exchange
  • Verbal (in-person, telephone, video conferencing)
  • Paper-based (fax, copies, printouts)
  • Other methods (texting, email, CD)
• Added A2123 Provision of Current Reconciled Medication List to Resident at Discharge. At the time of discharge, did your facility provide the resident’s current reconciled medication list to the resident, family and/or caregiver?
  • No
  • Yes
• Added A2124 Route of Current Reconciled Medication List Transmission to resident. Indicate the route(s) of transmission of the current reconciled medication list to the resident/family/caregiver (check all that apply)
  • Electronic Health Record (electronic access to patient portal)
  • Health Information Exchange
  • Verbal (in-person, telephone, video-conferencing)
  • Paper-based (fax, copies, printouts)
  • Other methods (texting, email, CD)

Section B:

• Added B1300 Health Literacy. How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?
  • Never
  • Rarely
  • Sometimes
  • Often
  • Always
  • Resident declines to respond
  • Resident unable to respond

Section C:

No changes

Section D:

• D0200 and D0300 removed.
• D0150 Resident Mood Interview *Now may only be a 2-part questionnaire based on resident’s answers. Noted as a PHQ-2 to 9
  • If the resident is coded as a 2 or 3 (symptom frequency between 7-14 days) when answering if the resident has little interest or pleasure in doing things and feeling down, depressed or hopeless then continue asking questions 3-9.
  • If the resident is not coded as a 2 or 3 on symptom frequency, end the PHQ interview.
• Note the staff interview for Moods has not changed.
• Added D0700 – Social Isolation. How often do you feel lonely or isolated from those around you?
  • Never
  • Rarely
  • Sometimes
  • Often
  • Always
  • Resident declines to respond
  • Resident unable to respond

Section E:

No changes

Section F:

No changes

Section G:

• Removed entirely

Section GG:

• Changed G0400 to GG0115 – Functional Limitation in ROM. No changes under this section.
• Changed G0600 to GG0120 – Mobility Devices. No changes under this section.
• GG0130 Self-Care Admission and GG0170 (Mobility). Complete both columns (admission performance and discharge goal) if A0310A = 01 (OBRA Admission) or A0310B=01 (Medicare PPS 5-day), the stay begins on A2400B. If A0310B=99 (not PPS assessment), the stay begins on A1600 and only column 1 (admission performance) is required.
  • On OBRA/Interim GG0130 assessment period is the ARD + 2 days.
  • On OBRA/Interim GG0170 Mobility does not include walking 10 feet on uneven surface, 1 step (curb), 4 steps, 12 steps, and picking up an object.
• Changed G0110J (personal hygiene) to GG0130I.
• GG0130 and GG0170 completed on discharge if A0310F = 10 or 11 (Discharge return not anticipated and Discharge return anticipated) or A0310H = 01 (SNF PPS discharge assessment).

Section H:

No changes

Section I:

No changes

Section J:

• J0410 – Pain frequency same question, however, responses were inverted (01 = rarely, 02 = occasionally, 03 = frequently, 04 = almost constantly, 09 = unable to answer).
• J0510 – Pain effect on Sleep changed. Ask resident “over the past 5 days, how much of the time has pain made it hard for you to sleep at night?” with responses including rarely or not at all, occasionally, frequently, almost constantly or unable to answer.
• J0520 – Pain interference with therapy activities. Ask the resident “over the past 5 days, how often have you limited your participation in rehabilitation therapy sessions due to pain?” with answers including does not apply, I have not received therapy sessions, rarely or not at all, occasionally, frequently, almost constantly, unable to answer.
• J0530 – Pain interference with day-to-day activities. Ask the resident “over the past 5 days how often have you limited your day-to-day activities (excluding rehabilitation therapy sessions) because of pain?” including answers rarely or not at all, occasionally, frequently, almost constantly, unable to answer.
• J2800 – Genitourinary Surgery – changed wording instead of “male or female organs” will now say “involving genital systems”.

Section K:

• K0520 Nutritional approaches
  • Changed to have 4 columns including:
    • 1. On admission (assessment period days 1-3 of SNF PPS stay starting with A2400B)
    • 2. While not a resident (only check column 2 if resident entered [admit or reentry] in the last 7 days, if resident entered 7 or more days ago leave column 2 blank)
    • 3. While a resident (while a resident at the facility and within the last 8 days)
    • 4. At discharge (assessment period is the last 3 days of the SNF PPS stay ending on A2400C.
  • Items A, B, C, D, and Z remained the same.

Section L:

No changes

Section M:

No changes

Section N:

• Changed N0410 to N0415: High Risk Drug Classes and Indication.
  • Columns include:
    • 1. Is taking (check if the resident is taking any medications by pharmacological classification, not how it is used, during the last 7 days or since admission/entry or reentry if less than 7 days).
    • 2. Indication noted (if column 1 is checked, check if there is an indication noted for all medications in the drug class).
  • Added high risk drug classes including antiplatelet and hypoglycemic (including insulin). Also added Z. none of the above as an option to code for column 1.

Section O:

• Changed O0100 to O0110. Special treatments, procedures, and programs. Check all of the following treatments, procedures, and programs that were performed.
  • Now 3 columns including:
    • On admission (assessment period is day 1 through 3 of the SNF PPS stay starting with A2400B.
    • While a resident (performed while a resident and within the last 14 days). Note some sections are blocked out for this column.
    • At discharge.
  • Added several subcategories to treatments, procedures and programs.
    • Chemotherapy – added IV, oral, other.
    • Oxygen therapy – added continuous, intermittent, high-concentration.
    • Suctioning – added scheduled and as needed.
    • Non Invasive mechanical ventilator – added BiPAP and CPAP
    • IV medications – added vasoactive, antibiotics, anticoagulants, other.
    • Dialysis – added hemodialysis and peritoneal.
    • Blocked out admit and discharge for both K1 (hospice) and M1 (isolation or quarantine).
    • Added IV access – peripheral, midline, central.
• Removed O0600 Physician Examinations
• Removed O0700 Physician Orders

Section P:

No changes

Section Q:

• Changed Q0100 to Q0110: Participation in assessment and goal setting. Identify all participants in the assessment process. Including additional options such as resident, family, significant other, legal guardian, other legal representative and none of the above.
• Changed Q0300 to:
  • Q0310A: Resident’s overall goal for discharge established during the assessment process. Including options of discharge to the community, remain in this facility, discharge to another facility, unknown or uncertain.
  • Q0310B: Indicate source for Q0310A: Resident, family, significant other, legal guardian, other legally authorized representative, none of the above.
• Changed Q0550B to Q0550C: Indicate source for information for Q0550A (resident’s preference to avoid being asked question Q0500B). Answers include resident, family, significant other, legal guardian, other legally authorized representative and none of the above.
• Changed Q0600 to Q0610: Has a referral been made to local contact agency (LCA)? Answers include No and Yes.
• Added Q0620 (complete if Q0610=0 or No) indicate reason why referral to LCA was not made:
  • LCA unknown
  • Referral previously made
  • Referral not wanted
  • Discharge date is 3 or fewer months away.
  • Discharge date is more than 3 months away.

Section V:

No changes

Section X:

• Removed X0570 – Optional State Assessment

Section Z:

No changes