The RAI Manual is CMS’s official guide to MDS 3.0. This manual contains six chapters plus appendices. Chapter 3 includes step-by-step instructions for completing each section of the MDS 3.0. Since Chapter 3 Section J relates to Health Conditions the letter J comes before all page numbers in this section. The RAI Manual could take between 3 to 10 minutes to download.

Directions: When you follow the link below, you will open the MDS 3.0 RAI Manual page on the U.S. Department of Health and Human Service, Centers for Medicare and Medicaid Services (CMS) site. Once you are on this page, scroll to the download section. Select MDS 3.0 RAI Manual.

Link to the RAI Manual

Directions: When you follow the link below, you will open the MDS3.0 Technical Information page on the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS ) site. Once you are on this page, scroll to the download section. Sometimes you may find two releases of the Item Subsets in the download section; you will need to pay attention to the dates to get the right one to meet your needs. Select MDS 3.0 Item Subsets to download the files.

Link to MDS 3.0 Item Subset forms

Instructor Guides

This link will take you to PDF files of PowerPoint Slides with Instructor Notes used in CMS Training of Trainers. You can go through this training material at your own pace. You may find it helpful to have a copy of the MDS 3.0 forms when you review this information. Please refer to the RAI Manual and CMS Transmittals of Changes.

 

Presentation Slides

This link will take you to the CMS PowerPoint Slides developed for Training of Trainers for Section J. This PowerPoint includes only the slides; it does not include trainer notes or audio of the training.

 

Supplemental Training Handouts

This link will take you to PDF files of MDS 3.0 Training Aids for Section J: Health Conditions.

 

Training Videos

If you would like to see a one hour and twenty-five minute video of the actual CMS Training of Trainers session on Section J: Health Conditions presented by Ann Spenard (held in August 2010) view this YouTube video.

For more training videos, this link will take you to a list of MDS 3.0 videos on YouTube; it is filtered by date. Beginning at the top, you can view the most videos that have been uploaded on the subject of MDS 3.0. Please note that several of the videos have been uploaded by CMSHHSGOV. While there are many videos on this YouTube channel, the videos posted by CMS would be most recommended by the State of Maine as this is the primary source of guidance on the MDS 3.0 from CMS.

Some things, such as interview techniques have not changed since the implementation of MDS 3.0 in 2011, other sections may not have current information.

Certain responses to questions in the MDS 3.0 will point to conditions, symptoms and other areas of concern that need further assessment in order to help the facility develop a comprehensive individualized care plan. These responses will “trigger” (Care Area Trigger, CAT ) the need to complete a Care Area Assessment (CAA). Chapter 4 of the RAI Manual covers the Care Area Assessment (CAA) Process and Care Planning.

Directions: When you follow the link below, you will open the MDS 3.0 RAI Manual page located on the U.S. Department of Health and Human Service, Centers for Medicaid and Medicare Services (CMS) site. Once you are on this page, scroll to the download section. Select MDS 3.0 RAI Manual. See Chapter 4 in the MDS 3.0 RAI Manual.

Link to CAAs and CATs material

Responses to the following Items in Section J: Health Conditions may trigger the facility to conduct a Care Area Assessment.

• J0400 (CAA 19 – Pain)
• J0500A (CAA 19 – Pain)
• J0500B (CAA 19 – Pain)
• J0600A (CAA 19 – Pain)
• J0600B (CAA 19 – Pain)
• J0800A (CAA 19 – Pain)
• J0800B (CAA 19 – Pain)
• J0800C (CAA 19 – Pain)
• J0800D (CAA 19 – Pain)
• J1550A (CAA 14 – Dehydration/Fluid Maintenance)
• J1550B (CAA 14 – Dehydration/Fluid Maintenance)
• J1500C (CAA 12 – Nutritional Status & CAA 14 – Dehydration/Fluid Maintenance)
• J1550D (CAA 14 – Dehydration/Fluid Maintenance)
• J1700A (CAA 11 – Falls)
• J1700B (CAA 11 – Falls)
• J1800 (CAA 11 – Falls)

Additional, compound responses to the following sections of the MDS 3.0 can trigger a Care Area Assessment directly related to Section J: Health Conditions

• A0310A (CAA 11 – Falls)

Long Term Care facilities receive reimbursement through two government programs: Medicare and MaineCare. Both programs reimburse Long Term Care facilities based on measures of the intensity of care and services required for each resident. Case Mix refers to the aggregate level of services and care needed by all the residents of a Long Term Care facility.

Link to Case Mix Manuals

Medicare reimbursement is based on a category-based classification system called Resource Utilization Group IV (RUG-IV). Certain responses on the MDS 3.0 determine assignment of a resident to a RUG-IV group. Medicare reimbursement guidelines are the same all across the country.

Medicaid reimbursement rules and guidelines differ from state to state. Currently Maine's Medicaid program (called MaineCare) uses a Case Mix system that differs from the Medicare system.

CMS does not require the completion of C0600 and C0700. However, the State of Maine does require these items to be completed in order to calculate Case Mix payment.

Some questions in Section J: Health Conditions affect Case Mix for RUG-IV (Medicare) and RUG-III (MaineCare). Select the link below for a copy of the MDS 3.0 Item Subset that identifies relevant questions.

Link to MDS 3.0 Item Subset (10/01/2018)