CMS Posts Updated MDS 3.0 RAI User’s Manual

The Centers for Medicare & Medicaid Services (CMS) has posted an updated Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual, version 1.20.11, dated October 2026. The RAI Manual provides the official guidance nursing facilities use to complete and code MDS assessments, which play an important role in resident assessment and care planning, quality reporting, and Medicare skilled nursing facility payment.

This version of the MDS 3.0 RAI User’s Manual includes several key refinements, including:

• Chapters 1, 2, and 3: Clarified that state or payer requirements do not replace, modify, or add to CMS coding requirements for non–Section S items.
• Chapter 2—Assessments for the RAI: New information regarding resident transfers during a public health emergency.
• Section A—Identification Information: Updated ethnicity and race reassessment guidance and removed the resident interview icon from several items.
• Sections C—Cognitive Patterns and D: Mood: Clarified language for coding when multiple resident interviews are conducted during the look-back period (e.g., Brief Interview for Mental Status [BIMS] and Resident Mood Interview [PHQ-2 to 9^©]).
• Section M—Skin Conditions: Updated guidance regarding coding pressure ulcers/injuries that are present on admission and that subsequently heal, then reopen; added new information on advanced wound care dressings, skin substitutes, and adhesive bandages.
• Section O—Special Treatments, Procedures, and Programs: Refined isolation criteria and skilled respiratory therapy guidance.
• Chapter 6—Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS): Revised terminology related to depression signs and symptoms.

Facilities should review the October 2026 manual and associated guidance with MDS coordinators and interdisciplinary team members, ensure assessment and coding processes reflect the most current CMS instructions, and review related FY 2027 updates, including the SNF Quality Reporting Program Measure Calculations and Reporting User’s Manual v8.0 for measures effective October 1, 2026. Facilities should also continue monitoring CMS’ MDS 3.0 RAI webpage for additional updates, supporting materials, and change tables.

PALTmed encourages members involved in nursing facility clinical leadership to stay informed about MDS and RAI updates and to work with their facility teams to understand changes that may affect resident assessment, documentation, quality reporting, and care planning.