Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD)

Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient Driven Payment Model and the Skilled Nursing Facility QRP (CMS-10387)

OMB: 0938-1140

IC ID: 197759

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

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Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 424.32 42 CFR 413.343 42 CFR 483.20 42 CFR 413.337

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10387 Nursing Home PPS (NP) Item Set MDS3.0_NP_PPS_v1.17.1.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10387 Nursing Home and Swing Bed OMRA (NO/SO) Item Set MDS3.0_NO_SO_OMRA-Other_v1.16.1.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10387 Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual (Cover Only) MDS RAI Manual v1.16 PRA cover page.pdf https://downloads.cms.gov/files/1-MDS-30-RAI-Manual-v1-16-October-1-2018.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set MDS3.0_NPE_Part_A_PPS_Discharge_v1.17.1.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10387 Interim Payment Assessment (IPA) Item Set MDS3.0_IPA_v1.17.1.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10387 Final SNF QRP New and Modified Items Final-SNF-QRP-Item-Mockups-Effective-October-1-2020.pdf https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Final-SNF-QRP-Item-Mockups-Effective-October-1-2020.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

15,471 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,905,042 0 0 0 0 4,905,042
Annual IC Time Burden (Hours) 4,169,286 0 0 0 0 4,169,286
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Crosswalk for Changes to MDS 3.0_PRA_Final_clean 08272019.docx 09/25/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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