MDS 3.0 and RUG IV: Are You Ready??

Even though the MDS has been used for more than a decade, it continues to be re-tooled. Now, seventeen years later, the MDS 3.0 and RUG-IV are scheduled for implementation in October, 2010. With roughly a half year left before this major change, we find ourselves wondering what needs to happen to assure success. Let’s look at the process from 10,000 feet.

Why did CMS decide to change the MDS?

Over time, the changes in nursing home care have brought forth provider and consumer concerns about how well the MDS 2.0 accurately captures resident information. CMS contracted with the RAND Corporation and Harvard University to draft revisions as well as test the MDS Version 3.0. The outcomes showed an opportunity for the MDS 3.0 to be more clinically relevant, have increased accuracy and validity (through integration of selected standardized scales), and increase the resident’s voice through interview items.

What are the goals of the MDS 3.0?

Much of the data on the MDS 3.0 is collected directly from the resident which has shown to increase accuracy. Such information should improve identification of resident needs which leads to enhanced, resident-centered care planning. Further, included are items from other care settings which are expected to increase communication among providers.


March/April – CMS will provide Train-the-Trainer sessions for selected groups. VCPI is attending.

October 1, 2010 – Implementation of the MDS 3.0, RUG IV, and the beginning of data collection for the new QIs / QMs.

So, what has changed?

The focus on the resident’s voice creates a resident-centered assessment. The resident becomes the source for information through multiple interviews unless participation is not possible. Such standardized interviews include the BIMS and the PHQ-9. Other interviews afford opportunities to obtain information regarding Daily and Activity Preferences as well as for pain. The MDS 3.0 is longer (2.0-8 pages, 3.0-26 pages). It has a revised numbering system as well as new reasons for assessment. There are CAAs (Care Area Assessments) to help link the MDS data to the care planning process. Lastly, the RUG IV system has gone from a 53 model to 66 with more categories, more opportunity to capture depression, ADL changes, and many other changes affecting services provided.

What can we do now to be ready?

Begin by developing an educational plan that is lead by experts and directed to ALL disciplines. This plan should include specific attention to development of interviewing skills. It is imperative accurate data is collected to assure strong clinical outcomes and successful reimbursement. This is no time to train one or two pertinent staff members and neglect the whole body. Next, check with your software vendors to assure they will be ready October 1, 2010. Review and revise your clinical systems to assure they are aligned with the MDS 3.0. Finally, communicate, communicate, and communicate some more!


American Association of Nurse Assessment Coordinators (AANAC)

MDS 3.0 Website

American Medical Directors Association Clinical Practice Guidelines

Lisa Hohlbein RN, RAC-CT, MSCN
VCPI Manager – Clinical Consulting