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The minimum data set (MDS) is a comprehensive assessment instrument designed to describe the medical condition, functional capacity, and treatment regimen of all persons residing/staying in skilled nursing facilities (SNFs)/nursing homes in the United States for more than 14 days.1 The MDS and its companion documentation, the resident assessment instrument (RAI), are mandated by the Social Security Act for all persons receiving Medicare and Medicaid funding. Regulations were amended in the Omnibus Budget Reconciliation Act (OBRA) in 1987 to include all nursing home residents.2 The form of the MDS in use since the fall of 2000 is version 2.0. In the fall of 2010, MDS version 3.0 was instituted along with a new set of resource utilization groups (RUGs) designed to guide the prospective payment for the care of Medicare A patients in SNFs.3
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The MDS is used as a component of two separate processes. One process is the designation of prospective payment rates received by facilities for the care of each patient. The other is to provide assessment and reassessment data to be used in the RAI process that was also mandated by OBRA. MDS data are utilized by state and local agencies to monitor the quality and safety of SNFs. This section will outline the personnel involved, time frames for reporting, and the various applications of MDS/RAI data.
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Federal law mandates that a registered nurse be designated for the coordination of MDS data collection and submission. By law, nurses may document all items of the MDS. Physicians, speech–language pathologists, occupational therapists, activities professionals, dietitians, and physical therapists may also complete MDS items. Information provided by all of the team members described above, including the patient, the family, direct care providers, such as nursing assistants, and ancillary service personnel may be used in the assessment process. Section Z contains a record of all of the persons completing a portion of the MDS and the specific sections they completed. Signing this section denotes legal responsibility for the accuracy of the information documented in the sections that are signed for.
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Prior to 1998, nursing homes were reimbursed on a cost basis. Reimbursement was based on the cost of the care provided with no consideration for the amount or type of services a resident actually received. This retrospective approach to reimbursement resulted in a more than 300% increase in healthcare expenditures by Medicare in the early to mid-1990s. Since 1998, SNFs have been paid a prospective, per diem rate that is based on the care that a patient has received in the recent past and the care that the facility can predict they will need in the near future based on function. Actual cost of the services provided to a patient is not a factor in the reimbursement that a facility receives. Data collected using the MDS are used to place residents into one of 53 RUGs. Each RUG is associated with a corresponding per diem rate ...