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Final MDS 3.0 RAI User's Manual (v1.20.11) Now Available

CMS has released the final version of the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual , effective October 1, 2026. Here's a quick rundown of what's changed.
Key updates include:
  • Chapters 1–3: Clarification that state or payer requirements cannot replace, modify, or add to CMS coding requirements for non–Section S items.
  • Chapter 2 (Assessments for the RAI): New guidance on resident transfers during a public health emergency.
  • Section A (Identification Information): Updated guidance on ethnicity and race reassessment, and the resident interview icon has been removed from several items.
  • Sections C (Cognitive Patterns) and D (Mood): Clearer coding language for cases where multiple resident interviews occur during the look-back period (e.g., BIMS and the PHQ-2 to 9© mood interview).
  • Section M (Skin Conditions): Revised guidance on coding pressure ulcers/injuries present on admission that heal and later reopen, plus new information on advanced wound care dressings, skin substitutes, and adhesive bandages.
  • Section O (Special Treatments, Procedures, and Programs): Refined isolation criteria and skilled respiratory therapy guidance.
  • Chapter 6 (Medicare SNF PPS): Updated terminology for depression signs and symptoms.
Beyond these highlights, numerous minor clarifications and corrections run throughout the manual — the chapter/section change tables included with the release spell out the specifics, so it's worth a look before October 1.

Where to find it:
Various minor alignments, clarifications, and corrections have been implemented throughout; specifics can be found in the included chapter/section change tables following the guidance.
   Staff Contact: mcarland[at]mehca.org

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