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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1140 can be found here:

2024-02-28 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form CMS-10387 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) Form and Instruction
CMS-10387 Nursing Home PPS (NP) Item Set Draft MDS3.0 NP Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Nursing Home PPS (NP) Item Set Draft MDS3.0 NP Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Long-Term Care Facility Resident Assessment Instrument ( Cover Page MDS RAI Manual v1.18.11.docx www.cms.gov/files/document/draftmds-30-rai-manual-v11811october2023.pdf-0 Form and Instruction
CMS-10387 Long-Term Care Facility Resident Assessment Instrument ( Cover Page MDS RAI Manual v1.18.11.docx www.cms.gov/files/document/draftmds-30-rai-manual-v11811october2023.pdf-0 Form and Instruction
CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set Draft MDS3.0 NPE Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set Draft MDS3.0 NPE Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Interim Payment Assessment (IPA) Item Set Draft MDS3.0 IPA Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Interim Payment Assessment (IPA) Item Set Draft MDS3.0 IPA Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Swing Bed Discharge (SD) Item Set Draft MDS3.0 SD Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Swing Bed Discharge (SD) Item Set Draft MDS3.0 SD Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Swing Bed PPS (SP) Item Set Draft MDS3.0 SP Item Set v1.18.11 Oct2023.pdf Form and Instruction
CMS-10387 Swing Bed PPS (SP) Item Set Draft MDS3.0 SP Item Set v1.18.11 Oct2023.pdf Form and Instruction
Draft MDS3.0_Item Set Change History_v1.18.11 Oct2023.pdf Crosswalk IC Document
Draft MDS3.0_Item Set Change History_v1.18.11 Oct2023.pdf Crosswalk IC Document
Draft MDS3.0 NP Item Set v1.18.11 Oct2023+ new items highlighted.docx NP Item set v1.18.11 new items IC Document
Draft MDS3.0 NP Item Set v1.18.11 Oct2023+ new items highlighted.docx NP Item set v1.18.11 new items IC Document
Draft MDS3.0 NPE Item Set v1.18.11 Oct2023+ new items highlighted.docx NPE Item Set v1.18.11 new items IC Document
Draft MDS3.0 NPE Item Set v1.18.11 Oct2023+ new items highlighted.docx NPE Item Set v1.18.11 new items IC Document
Draft MDS3.0 IPA Item Set v1.18.11 Oct2023+ new items highlighted.docx IPA Item Set v1.18.11 new items IC Document
Draft MDS3.0 IPA Item Set v1.18.11 Oct2023+ new items highlighted.docx IPA Item Set v1.18.11 new items IC Document
Draft MDS3.0 SD Item Set v1.18.11 Oct2023 + new items highlighted.docx SD Item Set v1.18.11 new items IC Document
Draft MDS3.0 SD Item Set v1.18.11 Oct2023 + new items highlighted.docx SD Item Set v1.18.11 new items IC Document
Draft MDS3.0 SP Item Set v1.18.11 Oct2023 + new items higlighted.docx SP Item Set v1.18.11 new item IC Document
Draft MDS3.0 SP Item Set v1.18.11 Oct2023 + new items higlighted.docx SP Item Set v1.18.11 new item IC Document
MDS3.0_NP_PPS_v1.17.2+ removed items redlined.docx NP item set v1.18.11 removed items IC Document
MDS3.0_NP_PPS_v1.17.2+ removed items redlined.docx NP item set v1.18.11 removed items IC Document
MDS3.0_NPE_Part_A_PPS_Discharge_v1.17.2 + removed items redlined.docx NPE item set v1.18.11 removed items IC Document
MDS3.0_NPE_Part_A_PPS_Discharge_v1.17.2 + removed items redlined.docx NPE item set v1.18.11 removed items IC Document
MDS3.0_IPA_v1.17.2 + removed items redlined.docx IPA item set v1.18.11 removed items IC Document
MDS3.0_IPA_v1.17.2 + removed items redlined.docx IPA item set v1.18.11 removed items IC Document
MDS3.0_SD_Dschg_v1.17.2 + removed items redlined.docx SD item set v1.18.11 removed items IC Document
MDS3.0_SD_Dschg_v1.17.2 + removed items redlined.docx SD item set v1.18.11 removed items IC Document
MDS3.0_SP_PPS_v1.17.2 + removed items redlined.docx SP item set v1.18.11 removed items IC Document
MDS3.0_SP_PPS_v1.17.2 + removed items redlined.docx SP item set v1.18.11 removed items IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	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)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 413.343 42 CFR 483.20 42 CFR 413.337 42 CFR 424.32

Information Collection Instruments:

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	Draft MDS3.0 NP Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10387	Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual (Cover Only)	Cover Page MDS RAI Manual v1.18.11.docx	https://www.cms.gov/files/document/draftmds-30-rai-manual-v11811october2023.pdf-0	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Nursing Home Part A PPS Discharge (NPE) Item Set	Draft MDS3.0 NPE Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Interim Payment Assessment (IPA) Item Set	Draft MDS3.0 IPA Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Swing Bed Discharge (SD) Item Set	Draft MDS3.0 SD Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Swing Bed PPS (SP) Item Set	Draft MDS3.0 SP Item Set v1.18.11 Oct2023.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,472	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,371,993	-1,533,049	4,905,042
Annual IC Time Burden (Hours)	2,866,194	-1,303,092	4,169,286
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Draft MDS3.0_Item Set Change History_v1.18.11 Oct2023.pdf	04/19/2023
NP Item set v1.18.11 new items	Draft MDS3.0 NP Item Set v1.18.11 Oct2023+ new items highlighted.docx	04/19/2023
NPE Item Set v1.18.11 new items	Draft MDS3.0 NPE Item Set v1.18.11 Oct2023+ new items highlighted.docx	04/19/2023
IPA Item Set v1.18.11 new items	Draft MDS3.0 IPA Item Set v1.18.11 Oct2023+ new items highlighted.docx	04/19/2023
SD Item Set v1.18.11 new items	Draft MDS3.0 SD Item Set v1.18.11 Oct2023 + new items highlighted.docx	04/19/2023
SP Item Set v1.18.11 new item	Draft MDS3.0 SP Item Set v1.18.11 Oct2023 + new items higlighted.docx	04/19/2023
NP item set v1.18.11 removed items	MDS3.0_NP_PPS_v1.17.2+ removed items redlined.docx	04/19/2023
NPE item set v1.18.11 removed items	MDS3.0_NPE_Part_A_PPS_Discharge_v1.17.2 + removed items redlined.docx	04/19/2023
IPA item set v1.18.11 removed items	MDS3.0_IPA_v1.17.2 + removed items redlined.docx	04/19/2023
SD item set v1.18.11 removed items	MDS3.0_SD_Dschg_v1.17.2 + removed items redlined.docx	04/19/2023
SP item set v1.18.11 removed items	MDS3.0_SP_PPS_v1.17.2 + removed items redlined.docx	04/19/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.