-3808
| Property | Specification |
| Data System | MDS |
| Data Specs | V3.02.1 |
| Edit Type | Format |
| Severity | Warning |
| Edit Text | When this Section S item is required by a State, it should equal one of the valid values indicated in the data specifications for that item. Note that for numeric items, signed numbers (with a leading plus or minus sign) should not be submitted. |
| Version Notes | [V3.02.1]-Added mappings to the following new items: S0195A-Z, S0509B, S0535, S0540, S0545, S0550, S0555, S6299, S6301A-Z, S6303E-H, S6304. |
| Item List | |
| Item ID | Description |
| S0101 | Admitted from Community |
| S0102 | Admitted from NH or SB |
| S0111 | Lived Alone |
| S0113 | Resident Living Situation Prior to Admission |
| S0114 | Resident has one or more support person(s) |
| S0115 | Spouse Location |
| S0120 | Prior Residence ZIP Code |
| S0122 | Prior Residence State |
| S0123 | Prior Residence County |
| S0125 | Prior Residence Town Code |
| S0130 | Highest Education Completed |
| S0140 | Physician License Number |
| S0141 | Physician Name |
| S0150 | State Resident ID |
| S0153 | Resident Identifier |
| S0160 | Specialty unit |
| S0161A | Requires specialized unit: dementia/Alzheimer |
| S0161B | Requires specialized unit: behavioral health |
| S0161C | Requires specialized unit: TBI |
| S0161D | Requires specialized unit: ventilator |
| S0161Z | Requires specialized unit: none of the above |
| S0165A | Specialty services: Dementia/Alzheimers |
| S0165B | Specialty services: Behavioral Health |
| S0165C | Specialty services: Traumatic Brain Injury |
| S0165D | Specialty services: Ventilator |
| S0165E | Specialty services: On-Site Dialysis |
| S0165Z | Specialty services: None of the Above |
| S0170A | Advanced directive: Guardian |
| S0170B | Advanced directive: DPOA-HC |
| S0170C | Advanced directive: Living will |
| S0170D | Advanced directive: Do not resuscitate |
| S0170E | Advanced directive: Do not hospitalize |
| S0170F | Advanced directive: Do not intubate |
| S0170G | Advanced directive: Feeding restrictions |
| S0170H | Advanced directive: Other treatment restrictions |
| S0170Z | Advanced directive: None of the above |
| S0171A | Resident healthcare proxy exists |
| S0171B | Resident healthcare proxy invoked |
| S0172A | Goal discussion: documentation received |
| S0172B | Goal discussion: hospital |
| S0172C | Goal discussion: previous NH |
| S0172D | Goal discussion: Home without home health services |
| S0172E | Goal discussion: Home with home health services |
| S0172F | Goal discussion: PCP office |
| S0172G | Goal discussion: Other |
| S0172H | Goal discussion: Not occur reason |
| S0173 | Documentation of goals of care discussion |
| S0174 | Resident has Advanced Directive |
| S0175 | Resident has POA for Health Care |
| S0180 | Discharged to Community |
| S0183 | Discharged prior to admission assessment |
| S0185 | Discharge to hospital-healthcare proxy involvement |
| S0195A | Lcl Cntct Agncy Rfrrl Dcsn - Active disch in prcss |
| S0195B | Lcl Cntct Agncy Rfrrl Dcsn - Legal reasons |
| S0195C | Lcl Cntct Agncy Rfrrl Dcsn - Clinical reasons |
| S0195D | Lcl Cntct Agncy Rfrrl Dcsn - Behavioral reasons |
| S0195Y | Lcl Cntct Agncy Rfrrl Dcsn - Other reasons |
| S0195Z | Lcl Cntct Agncy Rfrrl Dcsn - None of the Above |
| S0200A | Local Contact Agency Referral Decision |
| S0200B | Local Contact Agency Referral Decision - Other |
| S0500 | Level of Care |
| S0501 | CCNH RHNS Level of Care |
| S0505 | Level of care |
| S0509 | PASRR Level I completed prior to admission |
| S0509B | PASRR Level I completed - Significant change |
| S0510 | PASRR Screening Complete |
| S0511 | PASRR Level I Complete Date |
| S0512 | PASRR Level I |
| S0513 | PASRR Screening Outcome |
| S0514 | Was a PASRR Level I determination completed? |
| S0515 | Mst rcnt PASRR Lvl I or II determination cmpltn dt |
| S0520 | Reason for Admission |
| S0521 | Reason for Admission |
| S0535 | Referral - PASRR Level II Assessment Determination |
| S0540 | PASRR Level II Assessment Determination Made |
| S0545 | Most Recent PASRR Level II determination |
| S0550 | Outcome Of Most Recent Determination |
| S0555 | Approved Time Frame for NF Short Term Placement |
| S0600A | Meets criteria: requires ventilator 10+ hours |
| S0600B | Meets criteria: requires ventilator 16+ hours |
| S0600C | Meets criteria: Traumatic Brain Injury-Tier I |
| S0600D | Meets criteria: Traumatic Brain Injury-Tier II |
| S0600E | Meets criteria: Traumatic Brain Injury-Tier III |
| S0600Z | Meets criteria: none of the above |
| S1000 | Local Health Department Reporting |
| S1001 | State Health Department Reporting |
| S1002 | Local Health Department Reporting |
| S1003 | State Health Department Reporting |
| S1004 | Local/State Health Department Reporting |
| S1100A | Disease: Clostridium Difficile |
| S1100B | Disease: MRSA |
| S1100C | Disease: VRE |
| S1100D | Disease: VISA |
| S1100E | Disease: VRSA |
| S1100F | Disease: Other MDRO |
| S1100F1 | Disease: MDRO Name1 |
| S1100F2 | Disease: MDRO Name2 |
| S1100G | Disease: Tuberculosis |
| S1100H | Disease: Herpes Zoster |
| S1100I | Disease: Scabies |
| S1100J | Disease: CRE |
| S1100Z | Disease: None of the Above |
| S1150 | Active TBI Diagnosis |
| S1200A | Primary/secondary SMI dx: schizophrenia |
| S1200B | Primary/secondary SMI dx: delusional disorder |
| S1200C | Primary/secondary SMI dx: schizoaffective disorder |
| S1200D | Primary/secondary SMI dx: psychotic disorder NOS |
| S1200E | Primary/secondary SMI dx: bipolar disorder I |
| S1200F | Primary/secondary SMI dx: bipolar disorder II |
| S1200G | Primary/secondary SMI dx: cyclothymic disorder |
| S1200H | Primary/secondary SMI dx: bipolar disorder NOS |
| S1200I | Primary/secondary SMI dx: major depress recurrent |
| S1210A | Mental Health Diagnoses: Schizophrenia |
| S1210B | Mental Health Diagnoses: Delusional |
| S1210C | Mental Health Diagnoses: Schizoaffective disorder |
| S1210D | Mental Health Diagnoses: Psychotic disorder not sp |
| S1210E | Mental Health Diagnoses: Bipolar I mixed, manic |
| S1210F | Mental Health Diagnoses: Bipolar disorder II |
| S1210G | Mental Health Diagnoses: Cyclothymic disorder |
| S1210H | Mental Health Diagnoses: Bipolar disorder not sp |
| S1210I | Mental Health Diagnoses: Major depression, recur |
| S1210Z | Mental Health Diagnoses: None of the Above |
| S2000 | Capable of self-administration of medications |
| S2001 | Wishes to self-medicate |
| S2010 | Refused meds 3 days |
| S2011 | Staff support for meds 3 days |
| S2015 | Refused meds occasionally 30 days |
| S2016 | Refused meds frequently 30 days |
| S2040 | Behavior Management Program |
| S2050 | Resists grooming/hygiene |
| S2060A | Resident centered care: Oasis |
| S2060B | Resident centered care: habilitation therapy |
| S2060C | Resident centered care: hand in hand |
| S2060D | Resident centered care: consistent assignment |
| S2060E | Resident centered care: other |
| S2060Z | Resident centered care: none of the above |
| S3100A | Contractures: Hand |
| S3100B | Contractures: Wrist |
| S3100C | Contractures: Elbow |
| S3100D | Contractures: Shoulder |
| S3100E | Contractures: Neck |
| S3100F | Contractures: Ankle |
| S3100G | Contractures: Knee |
| S3100H | Contractures: Hip |
| S3100Z | Contractures: Other |
| S3200A | Dominant Side |
| S3200B | Use of dominant hand/arm |
| S3300 | Weight-based Equipment Need |
| S3305A | Lifting device for weight |
| S3305B | Wheelchair or mobility device for weight |
| S3305C | Bed for weight |
| S3305D | Seating for weight |
| S3305E | More than 2 staff for weight |
| S3305Y | Other for weight |
| S3310A | Therapy Services Billed - Medicare Part A |
| S3310B | Therapy Services Billed - Medicare Part B |
| S3310C | Therapy Services Billed - Managed Care Entity |
| S3310D | Therapy Services Billed - Medicaid |
| S3310Y | Therapy Services Billed - Other |
| S3310Z | Therapy Services Billed - None Of The Above |
| S3315A | COPD Treatment - Oxygen |
| S3315B | COPD Treatment - Inhaler/Nebulizer |
| S3315C | COPD Treatment - Acute Monitoring Of Respiratory |
| S3315D | COPD Treatment - Medications |
| S3315Y | COPD Treatment - Other |
| S3315Z | COPD Treatment - None Of The Above |
| S4000A | Harm: Self Injury/Self-injurious attempt |
| S4000B | Harm: Attempt was to kill self |
| S4000C | Harm: Considered injuring self |
| S4000D | Harm: Self-injury caregiver concern |
| S4010A | Hourly Interval Observation |
| S4010B | 15- Min. Interval Observation |
| S4010C | 5- Min. Interval Observation |
| S4010D | Constant Observation for < 1 hr |
| S4010E | Constant Observation for > 1 hr |
| S4500 | Substance Abuse: Alcoholic Drinks |
| S4510A | Substance Abuse: Inhalants |
| S4510B | Substance Abuse: Hallucinogens |
| S4510C | Substance Abuse: Cocaine and Crack |
| S4510D | Substance Abuse: Stimulants |
| S4510E | Substance Abuse: Opiates |
| S4510F | Substance Abuse: Cannabis |
| S5000 | Number of New Pressure Ulcers |
| S5005 | New Pressure Ulcer setting |
| S5010A1 | Pressure ulcer 1 location |
| S5010A2 | Pressure ulcer 1 status |
| S5010B1 | Pressure ulcer 2 location |
| S5010B2 | Pressure ulcer 2 status |
| S5010C1 | Pressure ulcer 3 location |
| S5010C2 | Pressure ulcer 3 status |
| S5010D1 | Pressure ulcer 4 location |
| S5010D2 | Pressure ulcer 4 status |
| S5010E1 | Pressure ulcer 5 location |
| S5010E2 | Pressure ulcer 5 status |
| S5010F1 | Pressure ulcer 6 location |
| S5010F2 | Pressure ulcer 6 status |
| S5010G1 | Pressure ulcer 7 location |
| S5010G2 | Pressure ulcer 7 status |
| S5010H1 | Pressure ulcer 8 location |
| S5010H2 | Pressure ulcer 8 status |
| S5010I1 | Pressure ulcer 9 location |
| S5010I2 | Pressure ulcer 9 status |
| S6000 | Parenteral/IV feeding in NH |
| S6005 | IV meds in NH |
| S6010 | Oxygen Therapy in NH |
| S6020A | Vent/resp specialized RN expertise |
| S6020B | Vent/resp specialized CNA training needed |
| S6020C | Vent/resp specialized therapy (PT,OT,RT) expertise |
| S6020D | Vent/resp specialized equipment |
| S6020Y | Vent/resp Other |
| S6020Z | Vent/resp None of the Above |
| S6022A | Vent/resp days licensed nurse: hourly intervals |
| S6022B | Vent/resp days licensed nurse: 15-minute intervals |
| S6022C | Vent/resp days licensed nurse: 5-minute intervals |
| S6023A | Vent/resp days CNA: hourly intervals |
| S6023B | Vent/resp days CNA: 15-minute intervals |
| S6023C | Vent/resp days CNA: 5-minute intervals |
| S6024A | Vent/resp days RT: hourly intervals |
| S6024B | Vent/resp days RT: 15-minute intervals |
| S6024C | Vent/resp days RT: 5-minute intervals |
| S6050 | Isolation precautions needed |
| S6051A | Isolation Precaution: Airborne |
| S6051B | Isolation Precaution: Contact |
| S6051C | Isolation Precaution: Droplet |
| S6051D | Isolation Precaution: Protective |
| S6052 | Isolation Required |
| S6053A | Met Isolation Requirements Start Date |
| S6053B | Met Isolation Requirements End Date |
| S6060A | Resident In Strict Isolation |
| S6060B | Strict Isolation Start Date |
| S6060C | Strict Isolation End Date |
| S6100A | Vaccination: Varicella |
| S6100B | Vaccination: Tetanus, diphtheria (Td) |
| S6100C | Vaccination: Tetanus, diphtheria, pertussis (Tdap) |
| S6100D | Vaccination: Measles, Mumps, Rubella (MMR) |
| S6100E | Vaccination: Other |
| S6100F1 | Vaccination: Other Name 1 |
| S6100F2 | Vaccination: Other Name 2 |
| S6100F3 | Vaccination: Other Name 3 |
| S6100Z | Vaccination: None of the above |
| S6200 | Number of Hospital Stays |
| S6201 | Number of Unreported Hospital Stays |
| S6202 | Hosp admissions w/overnight stay in last 90 days |
| S6205 | Number of Observation Stays |
| S6210 | Number of ER visits |
| S6211 | Number of Unreported ER Visits |
| S6212 | ER visits w/o overnight stay in last 90 days |
| S6220 | Alzheimer"s/Dementia Special Care Unit |
| S6230 | Has resident received antipsychotic |
| S6232 | Is resident currently receiving antipsychotic |
| S6234 | Attempt to reduce amount of antipsychotic |
| S6236 | Was reduction in antipsychotic maintained |
| S6299 | Resident Currently Has SUD Diagnosis |
| S6300 | Resident meds - opioid use disorder |
| S6301 | Standing order for Naloxone |
| S6301A | Current prescription or standing order - Opioid |
| S6301B | Current prescription or standing order - MOUD |
| S6301C | Current prescription or standing order - Naxalone |
| S6301Z | Current prescription or standing order - None |
| S6302 | Buprenorphine prescribed |
| S6303A | Counseling for opioid use disorder - No |
| S6303B | Counseling for opioid use disorder - onsite |
| S6303C | Counseling for opioid use disorder - alt location |
| S6303D | Counseling for opioid use disorder - virtually |
| S6303E | Counseling for opioid use disorder - No |
| S6303F | Counseling for opioid use disorder - onsite |
| S6303G | Counseling for opioid use disorder - alt location |
| S6303H | Counseling for opioid use disorder - virtually |
| S6304 | Resident diag warrants psychotropic medication |
| S6304A | Psychotropic med - Antidepressants |
| S6304B | Psychotropic med - Anxiolytics |
| S6304C | Psychotropic med - Antipsychotics |
| S6304D | Psychotropic med - Stimulants |
| S6304E | Psychotropic med - Chemical Dependency Adjuncts |
| S6304F | Psychotropic med - Monoamine Oxidase Inhibitors |
| S6304G | Psychotropic med - Mood Stabilizers |
| S6304H | Psychotropic med - Miscellaneous Drugs |
| S6304I | Psychotropic med - Other |
| S6305A | Active order for PRN psychotropics |
| S6305B | Last date received psychotropics |
| S6500 | Comfort care provided in the last 14 days |
| S7000 | Dental Care |
| S7001 | Dental Care Routine |
| S7002 | Dental Care Emergent |
| S7500A | Resident requires room w/o roommate |
| S7500B | Date resident placed in room w/o roommate |
| S7500C | Resident behavior puts roommate safety at risk |
| S7500D | Resident behavior infringes on roommate rights |
| S7500E | Resident care plan documents need for own room |
| S7500F | Resident requires own room - bariatric equipment |
| S7500G | Date resident placed in own room - bariatric equip |
| S7500H | Resident care plan - need for own room - bariatric |
| S8000A1 | Medicare - Primary Payor |
| S8000A2 | Medicare - Secondary Payor |
| S8000A3 | Medicare Payor |
| S8000B1 | Medicare Part A - Primary Payor |
| S8000B2 | Medicare Part A - Secondary Payor |
| S8000B3 | Medicare Part A Payor |
| S8000C1 | Medicare Part B - Primary Payor |
| S8000C2 | Medicare Part B - Secondary Payor |
| S8000C3 | Medicare Part B Payor |
| S8000D1 | Medicare Part C - Primary Payor |
| S8000D2 | Medicare Part C - Secondary Payor |
| S8000D3 | Medicare Part C Payor |
| S8000E1 | Medicare per diem - Primary Payor |
| S8000E2 | Medicare per diem - Secondary Payor |
| S8000E3 | Medicare per diem Payor |
| S8000Z | Medicare not a payment source |
| S8010A1 | In-state Medicaid - Primary Payor |
| S8010A2 | In-state Medicaid - Secondary Payor |
| S8010A3 | In-state Medicaid payor |
| S8010B1 | Out-of-state Medicaid - Primary Payor |
| S8010B2 | Out-of-state Medicaid - Secondary Payor |
| S8010B3 | Out-of-state Medicaid Payor |
| S8010C1 | Medicaid per diem - Primary Payor |
| S8010C2 | Medicaid per diem - Secondary Payor |
| S8010C3 | Medicaid per diem Payor |
| S8010D1 | Medicaid managed care per diem - Primary Payor |
| S8010D2 | Medicaid managed care per diem - Secondary Payor |
| S8010D3 | Medicaid managed care per diem Payor |
| S8010E1 | Medicaid per diem (not MC) - Primary Payor |
| S8010E2 | Medicaid per diem (not MC) - Secondary Payor |
| S8010E3 | Medicaid per diem (not MC) Payor |
| S8010F | Medicaid per diem type |
| S8010F1 | Medicaid Resident Liability - Primary Payor |
| S8010F2 | Medicaid Resident Liability - Secondary Payor |
| S8010F3 | Medicaid Resident Liability Payor |
| S8010G | Medicaid state source |
| S8010G1 | Medicare Co-Pay - Primary Payor |
| S8010G2 | Medicare Co-pay - Secondary Payor |
| S8010G3 | Medicare Co-pay Payor |
| S8010H1 | Picture Date reporting |
| S8010H2 | Medicaid Other - Secondary Payor |
| S8010H3 | Medicaid Other Payor |
| S8010I1 | Medicaid Pending - Primary Payor |
| S8010I2 | Medicaid Pending - Secondary Payor |
| S8010I3 | Medicaid Pending Payor |
| S8010Z | Medicaid not a payment source |
| S8015 | MMIS Identification Number |
| S8020A1 | Private - Primary Payor |
| S8020A2 | Private - Secondary Payor |
| S8020A3 | Private Payor |
| S8020B1 | Private per diem - Primary Payor |
| S8020B2 | Private per diem - Secondary Payor |
| S8020B3 | Private per diem Payor |
| S8020C1 | Private LTC insurance policy - Primary Payor |
| S8020C2 | Private LTC insurance policy - Secondary Payor |
| S8020C3 | Private LTC insurance policy |
| S8020Z | Private insurance not a payment source |
| S8030A1 | Self-pay - Primary Payor |
| S8030A2 | Self-pay - Secondary Payor |
| S8030A3 | Self-pay Payor |
| S8030B1 | Family pay - Primary Payor |
| S8030B2 | Family pay - Secondary Payor |
| S8030B3 | Family pay Payor |
| S8030C | Self or Family pay for full per diem |
| S8030Z | Self or Family not a payment source |
| S8040A1 | State Run Medical Assistance - Primary Payor |
| S8040A2 | State Run Medical Assistance - Secondary Payor |
| S8040A3 | State Run Medical Assistance Payor |
| S8040B1 | Tricare per diem - Primary Payor |
| S8040B2 | Tricare per diem - Secondary Payor |
| S8040B3 | Tricare per diem Payor |
| S8040C1 | VA per diem - Primary Payor |
| S8040C2 | VA per diem - Secondary Payor |
| S8040C3 | VA per diem Payor |
| S8040D1 | Other Public - Primary Payor |
| S8040D2 | Other Public - Secondary Payor |
| S8040D3 | Other Public Payor |
| S8040Z | Other government not a payment source |
| S8050A1 | Other - Primary Payor |
| S8050A2 | Other - Secondary Payor |
| S8050A3 | Other Payor |
| S8050B | Other Payor Name 1 |
| S8050C | Other Payor Name 2 |
| S8050D | Other Payor Name 3 |
| S8055 | Primary payor |
| S8099 | Payor: None of the Above |
| S8500 | Medicaid begin date |
| S8510A | Medicaid Therapeutic bed-hold days since last asmt |
| S8510B | Medicaid Therapeutic bed-hold days - YTD |
| S8512A | Medicaid hospital bed-hold days since last asmt |
| S8512B | Medicaid hospital bed-hold days - YTD |
| S8520A | Medicaid Leave Days Type 1 |
| S8520B | Leave Days for Medicaid begin date 1 |
| S8520C | Leave Days for Medicaid end date 1 |
| S8521A | Medicaid Leave Days Type 2 |
| S8521B | Leave Days for Medicaid begin date 2 |
| S8521C | Leave Days for Medicaid end date 2 |
| S9000 | IL Skills Training |
| S9001 | IL IDPH Subpart S criteria |
| S9002A | IL IDPH Subpart S: Schizophrenia |
| S9002B | IL IDPH Subpart S: Delusional disorder |
| S9002C | IL IDPH Subpart S: Schizoaffective disorder |
| S9002D | IL IDPH Subpart S:Psychotic disorder not specified |
| S9002E | IL IDPH Subpart S: Bipolar I mixed, manic, & depr |
| S9002F | IL IDPH Subpart S: Bipolar disorder II |
| S9002G | IL IDPH Subpart S: Cyclothymic disorder |
| S9002H | IL IDPH Subpart S: Bipolar disorder not specified |
| S9002I | IL IDPH Subpart S: Major depression, recurrent |
| S9003 | IL IDPH Subpart S: Ancillary |
| S9020 | FL FRAES number |
| S9040A | CA POLST |
| S9040B | CA POLST Section A |
| S9040C | CA POLST Section B |
| S9040C1 | CA POLST Section B (revised) |
| S9040D | CA POLST Section C |
| S9040D1 | CA POLST Section C (revised) |
| S9040E | CA POLST D phys/nurse prac/phys asst signature |
| S9040F | CA POLST D resident signature |
| S9040G | CA POLST D discussed with patient or decisionmaker |
| S9040H | CA POLST advanced directive |
| S9060 | NY Medicaid add-on eligibility |
| S9080A | PA MA CASE-MIX |
| S9080B | PA MA CASE-MIX Date |
| S9080C | PA MA CASE-MIX Access Card Number |
| S9080D | PA MA CASE-MIX MA NF Effective Date |
| S9080E | PA MA CASE-MIX Day One MA |
| S9085A | Resident enrolled in Community HealthChoices (CHC) |
| S9085B | CHC effective date |
| S9085C | CHC product name |
| S9085D | CHC member ID |
| S9100A | VA Room & Board Payment Assessment Reference Date |
| S9100B | VA Room & Board Payment Entry Date |
| S9100C | VA Medicaid Room & Board initial date |
| S9120 | CT Approved LTC |
| S9140 | Completed LAPOST |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 05/22/2024 02:22:32 PM