CMS releases updated MDS 3.0 RAI User’s Manual

The Centers for Medicare & Medicaid Services released a revised version of the MDS 3.0 RAI User’s Manual. Effective October 1, 2013, this updated version incorporates clarifications to existing coding and transmission policy, integrates previously published questions and answers into the appropriate sections and addresses requested clarifications and scenarios concerning complex areas.

Stay tuned for a more detailed overview of the recent changes.

Access the updated manual here.


  1. debbie pollard

    I was needing clarification. Is cms saying when you are doing adl coding. if you had for example two 2s two 3s and three 1s that you would code it supervision because of having three ones. please clarify

  2. diana bulich

    this is correct. the rule of three applies in this case. however in a case where you do not have three of any of the above you then revert to the use of the algorythim.

  3. Teresa

    You don’t need to use the algorithm at all. It can be used to augment the instructions, but it is not necessary at all to use. If all you have documented for the 24/7 period of time is that the resident had an ADL where they required 2x Extensive, 2x Limited and 3x Supervision, I’d first wonder what was going on the rest of the week. This scenario seems like it would only happen if the person was in the facility for a day or less or one of the exempt codes (e.g. Independent) was used the rest of the time. The actual ADL definitions apply when an ADL occurs three times or more. In this example the ADL occurred 8 times, so you’re good there. When looking at the first rule of three it says that if an activity occurs three or more times at any one level, you code that level. So in this instance, you would code Supervision because it is the level that occurred three or more times out of the 8 times the ADL occurred. This is true even though the other times the ADL occurred the actual assistance required was of a more dependent nature, and that is because the other times the ADL occurred, those levels occurred less than three times each (2x limited, 2x Extensive).

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