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)

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 CMS-10387 - Nursing Home PPS (NP) Item Set.pdf Form and Instruction
CMS-10387 Long-Term Care Facility Resident Assessment Instrument ( Draft_MDS-3.0-RAI-Manual-v1.19.1_October_2024.pdf www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual Form and Instruction
CMS-10387 Nursing Home Part A PPS Discharge (NPE) Item Set CMS-10387 - Nursing Home Part A PPS Discharge (NPE) Item-Set.pdf Form and Instruction
CMS-10387 Interim Payment Assessment (IPA) Item Set CMS-10387 - Interim Payment Assessment (IPA) -Item-Set.pdf Form and Instruction
CMS-10387 Swing Bed Discharge (SD) Item Set CMS-10387 - Swing Bed Discharge (SD) Item Set.pdf Form and Instruction
CMS-10387 Swing Bed PPS (SP) Item Set CMS-10387 - Swing Bed PPS SP Item Set.pdf Form and Instruction
CMS-10387 - Crosswalk of Changes.pdf Item Data Set Changes IC Document

Information Collection (IC) Details

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	CMS-10387 - Nursing Home PPS (NP) Item Set.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10387	Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual (Cover Only)	Draft_MDS-3.0-RAI-Manual-v1.19.1_October_2024.pdf	https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Nursing Home Part A PPS Discharge (NPE) Item Set	CMS-10387 - Nursing Home Part A PPS Discharge (NPE) Item-Set.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Interim Payment Assessment (IPA) Item Set	CMS-10387 - Interim Payment Assessment (IPA) -Item-Set.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Swing Bed Discharge (SD) Item Set	CMS-10387 - Swing Bed Discharge (SD) Item Set.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10387	Swing Bed PPS (SP) Item Set	CMS-10387 - Swing Bed PPS SP Item Set.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Long Term Care-Minimum Data Set'' (MDS), System No. 09-70-1517	FR Citation: 72 FR 12801

Number of Respondents: 15,253	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 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,784,397	-684,786	3,469,183
Annual IC Time Burden (Hours)	2,682,974	-178,377	2,861,351
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Item Data Set Changes	CMS-10387 - Crosswalk of Changes.pdf	07/15/2025

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