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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)

IC 197759 under ICR 202509-0938-001 · OMB 0938-1140.

Documents and Forms
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Form and Instruction
Form and Instruction
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Form and Instruction
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Form and Instruction
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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 413.343 42 CFR 424.32 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 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

Health Health Care Services

Long Term Care-Minimum Data Set'' (MDS), System No. 09-70-1517  72 FR 12801

15,253 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 2,784,397 0 0 -684,786 0 3,469,183
Annual IC Time Burden (Hours) 2,682,974 0 0 -178,377 0 2,861,351
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk of Changes CMS-10387 - Crosswalk of Changes - MDS 3.0 Item Set.pdf 09/02/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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