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Section D: Mood
Section D Intent:
The items in this section address mood distress, a serious condition that is underdiagnosed and undertreated in the nursing home and is associated with significant morbidity. It is particularly important to identify signs and symptoms of mood distress among nursing home residents because these signs and symptoms can be treatable.
It is important to note that coding the presence of indicators in Section D does not automatically mean that the resident has a diagnosis of depression or other mood disorder. Assessors do not make or assign a diagnosis in Section D, they simply record the presence or absence of specific clinical mood indicators. Facility staff should recognize these indicators and consider them when developing the resident’s individualized care plan. (CMS’s Resident Assessment Instrument (RAI) Manual, Chapter 3).
Select the topic to view or close the training information.
RAI Manual for MDS 3.0
The RAI Manual is CMS’s official guide to MDS 3.0. This manual contains six chapters plus appendices. Chapter 3 includes step-by-step instructions for completing each section of the MDS 3.0. Since Chapter 3 Section D relates to Mood the letter D comes before all page numbers in this section. The RAI Manual could take between 3 to 10 minutes to download.
Directions: When you follow the link below, you will open the MDS 3.0 RAI Manual page on the U.S. Department of Health and Human Service, Centers for Medicare and Medicaid Services (CMS) site. Once you are on this page, scroll to the download section. Select the MDS 3.0 RAI Manual.
MDS 3.0 Forms (Resident Assessment & Care Screening All Item Listing)
Directions: When you follow the link below, you will open the MDS 3.0 Technical Information page on the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) site. Once you are on this page, scroll to the download section. Sometimes you may find two releases of the Item Subsets in the download section; you will need to pay attention to the dates to get the right one to meet your needs. Select MDS 3.0 Item Subsets to download the files.
MDS 3.0 Coding Training Section
Instructor Guides
This link will take you to PDF files of PowerPoint Slides with Instructor Notes used in CMS Training of Trainers. You can go through this training material at your own pace. You may find it helpful to have a copy of the MDS 3.0 forms when you review this information. Please refer to the RAI Manual and CMS Transmittals of Changes.
Presentation Slides
This link will take you to the CMS PowerPoint Slides developed for Training of Trainers for Section D. This PowerPoint includes only the slides; it does not include trainer notes or audio of the training.
Supplemental Training Handouts
There are no supplemental training handouts or interview aids for Section D.
Training Vidoes
If you would like to see a 51 minute video of the actual CMS Training of Trainers session on Section D: Mood presented by Dr. Deb Saliba (held in August 2010) view this YouTube video.
For more training videos, this link will take you to a list of MDS 3.0 videos on YouTube; it is filtered by date. Beginning at the top, you can view the most videos that have been uploaded on the subject of MDS 3.0. Please note that several of the videos have been uploaded by CMSHHSGOV. While there are many videos on this YouTube channel, the videos posted by CMS would be most recommended by the State of Maine as this is the primary source of guidance on the MDS 3.0 from CMS.
Some things, such as interview techniques have not changed since the implementation of MDS 3.0 in 2011, other sections may not have current information.
CAAs and CATs
Certain responses to questions in the MDS 3.0 will point to conditions, symptoms and other areas of concern that need further assessment in order to help the facility develop a comprehensive individualized care plan. These responses will “trigger” (Care Area Trigger, CAT) the need to complete a Care Area Assessment (CAA). Chapter 4 of the RAI Manual covers the Care Area Assessment (CAA) Process and Care Planning.
Directions: When you follow the link below, you will open the MDS 3.0 RAI Manual page located on the U.S. Department of Health and Human Service, Centers for Medicaid and Medicare Services (CMS) site. Once you are on this page, scroll to the download section. Select MDS 3.0 RAI Manual. See Chapter 4 in the MDS 3.0 RAI Manual.
Link to CAAs and CATs material
Responses to the following Items in Section D: Mood may trigger the facility to conduct a Care Area Assessment.
- D0200A1 (CAA 7 – Psychosocial Well-Being & CAA 10 - Activities)
- D0200I1 (CAA 8 – Mood State)
- D0300 (CAA 8 – Mood State)
- D0500A1 (CAA 7 – Psychosocial Well-Being & CAA 10 - Activities)
- D0500I1 (CAA 8 – Mood State)
- D0600 (CAA 8 – Mood State)
Additional, compound responses to the following sections of the MDS 3.0 can trigger a Care Area Assessment directly related to Section D: Mood.
- A0310A (CAA 8 – Mood State)
- V0100E (CAA 8 – Mood State)
- V0100F (CAA8 – Mood State)
Case Mix
Long Term Care facilities receive reimbursement through two government programs: Medicare and MaineCare. Both programs reimburse Long Term Care facilities based on measures of the intensity of care and services required for each resident. Case Mix refers to the aggregate level of services and care needed by all the residents of a Long Term Care facility.
Medicare reimbursement is based on a category-based classification system called Resource Utilization Group IV (RUG-IV). Certain responses on the MDS 3.0 determine assignment of a resident to a RUG-IV group. Medicare reimbursement guidelines are the same all across the country.
Medicaid reimbursement rules and guidelines differ from state to state. Currently Maine's Medicaid program (called MaineCare) uses a Case Mix system that differs from the Medicare system.
CMS does not require the completion of C0600 and C0700. However, the State of Maine does require these items to be completed in order to calculate Case Mix payment.
Some questions in Section D: Mood effect Case Mix for RUG-IV (Medicare) and RUG-III (MaineCare). Select the link below for a copy of the MDS 3.0 Item Subset that identifies relevant questions.
Link to MDS 3.0 Item Subset (10/01/2018)
