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MDS Applicability

If you have read the information posted within this MDS web site and/or any other documentation and still are not certain if the MDS and its requirements apply to you, please read the following:

DOES MDS APPLY TO ME?

If you are a certified Medicare or Medicaid nursing facility, then you must complete, record, encode and transmit the MDS (Minimum Data Set) for all residents in your facility, regardless of age, diagnosis, length of stay or payment category.

You know that you are certified if you have a Medicare or Medicaid provider number. This is a six-digit number used for Medicare and/or Medicaid certification and for Medicare reimbursement. The provider number consists of a two-digit State code, and a four-digit alpha numeric consisting of the 5000 series for Title 18 Skilled Nursing Facilities or dually-certified facilities, and A000, E000, or F000 numbers for Title 19 only Nursing Facilities, e.g. 37-5000 or 45E000. All or part of an institution may be certified to participate in Medicare or Medicaid.

Failure to complete and transmit the MDS will be considered noncompliance with a Medicare and/or Medicaid Requirement of Participation (42 CFR 483.20), and may result in an enforcement action.

MDS requirements do not apply in the following situations:

  • Unless otherwise required by your State, licensed-only nursing facilities that do not participate in either Medicare or Medicaid.
  • Unless otherwise mandated by the State, individuals residing in non-certified units of nursing homes. However, the non-certified units must be physically distinguishable from the larger institution, i.e. a wing, separate building, a floor, a unit, a hallway, one side of a corridor, or several rooms at the end of a hallway.

If in doubt about whether or not your facility, or a specific resident, is subject to MDS requirements, please contact the MDS coordinator at your State Agency.  See Downloads for a list of MDS Coordinators.