RAI/MDS 3.0 Section Q


The North Carolina Health Care Facilities Association (NCHCFA) made one of its top priorities a collaborative effort with the North Carolina Division of Health Service Regulation (DHSR), to facilitate an efficient transition to the MDS 3.0 based Resident Assessment Instrument (RAI)  the effective date being October 1, 2010 .

One of greatest resources in North Carolina is the expertise and investment in quality we have in DHSR’s Quality Evaluative Systems of which Cindy DePorter, MSW is the Branch Manager and State RAI Coordinator. Ms. DePorter has already established a list serve.  NC Departmental policy dictates that the group be private (by invitation only).  To request an invitation, please send an email to: NC_MDS_3_Rollout-Updates-subscribe@yahoogroups.com and include your facility or corporation information.  A list serve offers several ways for you to participate.  Upon joining the group, new members specify the ways they can receive messages whether individually or in a daily digest (compilation of 25 messages) or not receive messages at all and go to the group/website to read the discussions.  Members are also notified when a new file has been uploaded to the group.  At any time, a member can drop out of the group.


NC Departmental policy dictates that the group be private (by invitation only).  To request an invitation, please send an email including your facility or corporation information to:



The North Carolina Health Care Facilities Association had scheduled trainings in 2010. [closed]


The minimum data set specified by the Centers for Medicare and Medicaid Services (CMS) is the basis for the federally mandated Resident Assessment Instrument (RAI).  Multiple uses have been added throughout the instrument’s history. CMS seems to emphasize these uses with its implementation of MDS 3.0:  individualized care planning, public reporting of quality measures (QMs), developing QMs for swing beds, case mix reimbursement, confirmation of quality of care by the survey process.

Laudable goals for development of MDS 3.0 include giving prominence to resident voice in the assessment and care planning process. Appendix Q in the MDS 3.0 will address the resident’s desire to return home and will be assessed on admission assessment, quarterly assessment, upon significant change, and annually.  The resident or surrogate will provide the requested responses.    In the MDS 2.0, this response was generated by the assessor, now clearly this is an autonomous response by or for the resident.  Facilities will fulfill the resident’s right to choice by providing information pertaining to available resources, contacts, and options in a comprehensive discharge plan.  Note: There will be an inclusion of a skip pattern when indicated as per the Manual instructions for this Appendix.

An area CMS targeted for improved clinical relevancy that will strengthen clarity and accuracy of assessment while at the same time impacting resident voice, is the Confusion Assessment Model (CAM). The MDS 3.0 incorporates a great deal of assessment dependent upon resident interviews.  Resident voice is highly important in the clinical assessment of cognitive function, pain, mood and preferences in addition to participation in care planning and goal setting.  The CAM  will be highly relevant to the assessment process interview both clinically and in the survey process.

The role of the Resident Assessment Protocols (RAPs) and their accompanying data triggers grew in regulatory emphasis and requirement since the introduction of the RAI some 17 years ago.  With the growth of the RAPs regulatory importance, popularity and opinion of the RAP’s utility declined. Care Area Assessment (CAAs) Protocols with accompanying Care Area Triggers (CATs) have been developed by CMS.  While the use of CATs and assessment protocols are required, the assessors are not obligated to use the  protocols developed by CMS and may use a protocol of choice with  options provided in Appendix C of the MDS 3.0.

A very important statement you will hear during this overview is that the MDS 3.0 is not a ‘revision’ of the MDS 2.0.  It is a unique instrument that is a significant departure from the existing assessment instrument. Among the major changes are: emphasis on resident voice in the assessment process, replacement of the Resident Assessment Protocols (RAPS), Appendix Q’s assessment and discharge planning requirements, as well as the impact on the new Resource Utilization Groups (RUGs IV) for purposes of reimbursement.  In North Carolina these new RUGs will result in changes to the Medicaid Case Mix system as well. According to CMS, the catalysts for developing the MDS 3.0 included increasing user satisfaction, improving clinical relevancy, providing clearer definitions, creating a better format and eliminating poorly performing RAI items.



North Carolina’s Referral Process for MDS 3.0, Section Q

On October 1, 2010, nursing facilities across the country will begin using a new iteration of the Minimum Data Set, called MDS 3.0. The new version includes a revised Section Q designed to identify people residing in nursing facilities who may be interested in talking to someone about moving back into the community.

With guidance from the NCHCFA, DHHS’ Division of Medical Assistance, Office of Long Term Services and Supports, Division of Health Service Regulation and other entities are finalizing the referral process required as part of this MDS 3.0 Section Q implementation.   To find North Carolina’s Referral Process for MDS 3.0, Section Q, click here.

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