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State of California—Health and Human Services Agency
California Department of Public Health

AFL 23-32.1
November 3, 2023

Skilled Nursing Facilities (SNF)
Nursing Facilities (NF) and
Swing Beds Non-Critical Access Hospital (SB Non-CAH)

Centers for Medicare and Medicaid Service’s (CMS) Minimum Data Set (MDS) Resident Assessment Instrument (RAI) 3.0 Manual v1.18.11 went into effect October 1, 2023 
(This AFL supersedes AFL 23-32)


​All Facilities Letter (AFL) Summary​

  • This AFL notifies all Medicare and or Medicaid certified nursing facilities and non-critical access hospitals with swing bed agreements (“providers") of the release of the final version of the MDS RAI 3.0 Manual v1.18.11, and related resources, effective October 1, 2023.  
  • On October 1, 2023, California Medi-Cal providers ​​​will no longer be required to complete the additional Optional State Assessment (OSA).

​​Final Minimum Data Set (MDS) Resident Assessment Instrument (RAI) 3.0 Manual v1.18.11 and Related Resources

CMS has posted the final version of the MDS RAI 3.0 Manual v1.18.11, and related documents, that went into effect on October 1, 2023. The revised Manual contains substantial revisions related to Improving the Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Due to the scope of the revisions, CMS will not issue Replacement Pages for the MDS RAI 3.0 v1.18.11.    

CMS has provided electronic access to the finalized versions of the MDS Manual and related documents that include step by step guidance and training to aid providers in transitioning before October 1, 2023. 

MDS RAI 3.0 Manual and Items Sets, guidance, tools, and training to assist providers are located on the MDS RAI (Resident Assessment Instrument) Manual page. Downloadable manuals and related materials are available at the bottom of the page in the “Downloads' section. The MDS 3.0 Technical Information page can be accessed on the MDS 3.0 Technical Information page. The “Downloads" section at the bottom of the page includes data and technical information.

MDS 3.0 Training Resources and SNF Quality Reporting Program (QRP) information can be accessed on the SNF QRP Program webpage. This page provides access to the revised MDS Section changes training series. CMS also provides Post Acute Care (PAC) training accessed at the bottom of the page in the “Downloads" section. Questions regarding access to training materials can be submitted to the PAC training mailbox at Content-related questions can be submitted to the SNF QRP Help Desk at

Training regarding the SNF QRP program, aside from MDS Manual specific trainings, can be accessed on the Introduction to the SNF QRP and PAC Data and Quality Measures Training webpages.​

California Facilities No Longer Required to Complete the Optional State Assess​ment (OSA) for California Medi-Cal Recipients​

On October 1, 2019, all Medicare providers switched to PDPM and as of October 1, 2023, the Federal MDS assessments (Prospective Payment System (PPS) and Omnibus Budget Reconciliation Act (OBRA)) will no longer support RUG-III/IV grouper calculations. On that date, California facilities will no longer be required to complete the Optional State Assessment (OSA) for California Medi-Cal recipients.

Notable changes to the assessment under PDPM may require vendor software updates.

Other software changes include the transition from Section G, which has been removed, and portions of Section G are saved under Section GG (Functional Abilities and Goals) in the revised MDS 3.0 Manual 1.18.11. This step advances CMS's goal of standardized assessment items across payment settings using the PDPM Functional Score.

CMS MDS assessment submission and reporting functionality is accessible using Internet Quality Improvement and Evaluation System (iQIES).

iQIES training material and supporting guidelines can be found at the CMS iQIES Training Videos webpage. For information and instructions on how to register for an iQIES account, visit the CMS Register for an iQIES Account webpage

iQIES training videos can be viewed at the CMS iQIES Training Videos webpage and at the CMSHHSgov iQIES Training YouTube playlist.

CMS provides assistance for anyone who may have questions related to their web posting documents at the CMS Help webpage.

For additional MDS RAI questions, please contact the MDS help desk by email at  For MDS RAI technical assistance, please contact the ASPEN help desk at (916) 552-8910 or



Original signed by Cassie Dunham

Cassie Dunham

Deputy Director​

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