The Centers for Medicare & Medicaid Services (CMS) has released version 1.20.11 of the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual. The updated manual is effective October 1, 2026.
At a high level, key updates include:
- Clarification that M D S items (non-Section S must be coded according to the CMS item definitions, coding instructions, coding tips, and response options in the manual. State or other payer requirements do not replace, modify, or add to the item definitions, coding instructions, coding tips, or response options specified in the manual.
- Revised assessment and coding guidance, including instructions for emergency transfers and resident interviews.
- Clarifications related to coding shortness of breath.
- Expanded guidance for coding pressure ulcers and injuries, surgical wounds, other skin conditions, and whether an ulcer or injury was present on admission.
- Refined instructions for coding isolation and skilled respiratory therapy services.
- Clarifying language was added to the depression end split for the Patient-Driven Payment Model in Chapter 6.
Full details of all updates and revisions are outlined in the changes tables in the RAI Manual.