Questions Submitted by the Public, by Date Posted to the Website. Minimum Data Set (MDS) reports by long-term care facilities


Are long-term care facilities required to submit their Minimum Data Set (MDS) reports using a HIPAA standard? The reports are not used for request of payment.


No. The Minimum Data Set (MDS) is an array of data that nursing facilities are required to collect and report on each of their residents as a condition for Medicare and Medicaid certification and payment under the Nursing Home Reform Act of 1987. See 42 C.F.R. Part 483, Subpart F for MDS requirements.

The MDS includes a comprehensive assessment of many factors concerning a patient's care during a stay in a facility, and therefore contains a substantial amount of data beyond that needed for the 837 claim. The Medicare program and a number of State Medicaid programs use data elements extracted from the MDS to compute payment rates. In some States, nursing facilities use MDS data to construct individual claims for payment. These are permitted uses for this data. By the compliance date for the HIPAA transactions, any individual claims for payment constructed from this data must be in the standard 837 format. However, reporting of patient assessment data using MDS is not one of the standard transactions adopted in the Transactions Rule.