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Reporting And Data

Minimum Data Set (MDS)

Latest Update: August 11, 2020
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Reporting Information

The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes.  This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.  Care Area Assessments (CAAs) are part of this process, and provide the foundation upon which a resident's individual care plan is formulated.  MDS assessments are completed for all residents in certified nursing homes, regardless of source of payment for the individual resident. 

Responsible Party

Who Must Report?

Nursing homes and non-critical access hospitals with swing bed agreements must participate in this process. Participants in the assessment process are health care professionals and direct care staff such as Registered Nurses, Licensed Practical/Vocational Nurses, Therapists, Social Services, Activities and Dietary staff employed by the nursing home.

Deadlines

When Do I Report?

MDS assessments are required for residents on admission to the nursing facility, quarterly (at least once every three months), annually (at least once every 12 months), periodically (significant changes in patient's condition), and on discharge. The MDS must be completed within 14 days.

Method

How Do I Report?

MDS information is transmitted electronically by nursing homes to the national MDS database at CMS via the Internet Quality Improvement and Evaluation System (iQIES).

Note: Beginning in 2020, iQIES will replace and consolidate functionality from the QIES, CASPER and ASPEN legacy systems.

Contact Information

Service desk for iQIES: iqies@cms.hhs.gov or 800-339-9313

Benefit/Penalty

Why Should I Report?

Potential loss of CMS reimbursement for not reporting. Affects star rating on Nursing Home Compare.

Publicly Displayed

Link to the website/ranking/grading/etc. where the data is published

Nursing Home Compare

Note: Check your CASPER reports to help ensure data is submitted accurately.

Authority

The legal mandate requiring reporting

On September 18, 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The IMPACT Act requires the submission of standardized data by Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs). The IMPACT Act establishes a quality reporting program (QRP) for SNFs.

Notes

Any other pertinent information

Sections of MDS (Minimum Data Set):

  1. Identification Information
  2. Hearing, Speech and Vision
  3. Cognitive Patterns
  4. Mood
  5. Behavior
  6. Preferences for Customary Routine and Activities
  7. Functional Status
  8. Functional Abilities and Goals
  9. Bladder and Bowel
  10. Active Diagnoses
  11. Health Conditions
  12. Swallowing/Nutritional Status
  13. Oral/Dental Status
  14. Skin Conditions
  15. Medications
  16. Special Treatments, Procedures and Programs
  17. Restraints
  18. Participation in Assessment and Goal Setting
  19. Care Area Assessment (CAA) Summary
  20. Correction Request
  21. Assessment Administration
DISCLAIMER
Although many of these requirements apply to individual medical professionals and other types of hospitals and health care facilities, the information is presented solely to support Critical Access Hospitals. The reporting requirements and legal mandates on this site are not an exhaustive list and Nevada Rural Hospital Partners, Inc. bears no responsibility or liability for any hospitals' or providers' failure to comply with Federal or State laws or regulations.