Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient Driven Payment Model and the Skilled Nursing Facility QRP (CMS-10387)

The Minimum Data Set (MDS) is a uniform instrument used in every Medicare/Medicaid certified nursing home in the United States to assess resident condition. It was developed in response to the Landmark Institute of Medicine (IOM) Report on Nursing Home Quality in 1987 where the MDS was seen as a critical component in efforts to improve the quality of care in nursing homes. The Omnibus Reconciliation Act of 1987 (OBRA 1987) also set forth new provisions for Medicare and Medicaid related to new standards for care in the nursing home setting. From its inception, the MDS was intended to serve several purposes: (1) Collect data to inform care plans (2) To generate quality indicators to evaluate nursing homes and guide improvement interventions (3) To serve as a data source for nursing home payment systems. Pursuant to sections 4204(b) and 4214(d) of OBRA 1987, the current requirements related to the submission and retention of resident assessment data are not subject to the Paperwork Reduction Act (PRA), but it has been determined that requirements for SNF staff performing, encoding and patient assessment data necessary administer the payment rate methodology described in 413.337, are subject to the PRA. The SNF QRP was established in CMS-1622-F (August 4, 2015; 80 FR 46390) and began collecting data from SNFs in fiscal year (FY) 2016 using the MDS. As described in section 1899B (b)(1)(B) of the Social Security Act (the Act), SNFs are required to submit standardized patient assessment data with respect to the following categories: • Functional Status • Cognitive Function • Special Services, Treatments, and Interventions • Medical Conditions and Comorbidities • Impairments • Other categories deemed necessary and appropriate by the Secretary Both the Patient Driven Payment Model (PDPM) in the SNF PPS and the SNF QRP collect data through the MDS 3.0. The PDPM was described and adopted for SNFs and Swing Beds in CMS-1696-F (August 8, 2018; 83 FR 39162). This package is a request for a revision to the current Minimum Data Set (MDS) assessment instrument for the Skilled Nursing Facility (SNF). This package represents a request from the Centers for Medicare & Medicaid Services (CMS) to implement the MDS 3.0 v1.18.11 beginning October 1, 2023 to October 1, 2026 in order to meet the requirements of policies finalized in the Federal Fiscal Year (FY) 2020 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule (CMS-1718-F, RIN 0938-AT75). A PRA package was submitted at the time of the finalized policies and approved on 11/22/2019, but the compliance date for the finalized policies (10/01/2020) was delayed due to the COVID-19 public health emergency (PHE). Please note, however, the burden was never retracted, and the implementation of the instrument was simply delayed. While there has been no change in assessment-level burden since the approval of the MDS 3.0 v1.17.2, there has been a change in total burden since 2019 when the package was originally approved due to a decrease in the number of MDS assessments completed and a change in the hourly rate for clinicians completing the assessment.

The latest form for Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient Driven Payment Model and the Skilled Nursing Facility QRP (CMS-10387) expires 2028-11-30 and can be found here.