MDS News and Guidance

Decoding the MDS 3.0: What is Happening with Section D?

Polaris Group Profile
Polaris Group
September 7, 2023
August 29, 2023
Polaris Group Profile
Polaris Group
August 29, 2023

The Resident Mood Interview will be modified to the PHQ-2 to 9 with the new MDS 3.0. Use the Total Severity Score to enhance care planning.

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On October 1, 2023, the new MDS 3.0 will become effective and present major changes to many sections and revised coding procedures. Facilities will need to prepare now for the changes occurring in various sections. This blog is part of Polaris Group's Decoding the MDS 3.0 series which will explore the changes occurring in specific MDS sections.

What is happening with Section D: Resident Mood Interview and Total Severity Score?

Changes to Section D include:

  1. Renumbering of existing items
  2. Modifying the Resident Mood Interview to use the PHQ-2 to 9
  3. New guidance for whether a Resident Mood Interview should be conducted (D0100)
  4. The addition of social isolation (see Social Determinants of Health blog post for detailed information about this change).  

First, guidance for whether the Resident Mood Interview should be conducted has been modified such that if the resident cannot communicate, then the Staff Mood Interview should be conducted. Perhaps the biggest change will be the use of the PHQ-2 to 9 for the Resident Mood Interview. In MDS 3.0, the PHQ-2 will be administered for all residents. Then, if warranted, the remaining 7 items of the PHQ-9 will be administered.

The PHQ-9, the new component of MDS 3.0, is a multipurpose instrument for screening, monitoring, and measuring the severity of depression. This assessment incorporates DSM-IV depression diagnostic criteria into a brief self-report tool where residents rate the presence and frequency of symptoms.

Symptom presence: If mood symptoms are not present, the presence question is coded 0. If mood symptoms are present, the presence question is coded 1. If the resident was unable or chose not to complete the assessment, the presence question is coded 9.

Symptom frequency: To code frequency, read and show the resident a card with the symptom frequency options regarding symptoms in the last 2 weeks.

  • Code 0 = Never or 1 day
  • Code 1 = 2-6 days (several days)
  • Code 2 = 7-11 days (half or more of the days)
  • Code 3 = 12-14 days (nearly every day)

What changes to expect?

In MDS 3.0, the steps for assessment of the Resident Mood Interview are substantially different. First, the assessor with ask the first two questions (the PHQ-2). Each question must be asked in sequence to assess both symptom presence and frequency. Then, based on the responses, the assessor will determine whether to ask the remaining seven questions to form the full PHQ-9.

Reasons for administering ONLY the PHQ-2:

  1. If both of the first two questions are coded 9 (resident unable to complete the assessment, resident chose not to complete the assessment, or resident responded nonsensically to the assessment).
  2. If both of the first two questions are coded 0 or 1.

TIP: For all other scenarios, the remaining 7 items of the PHQ-9 should be asked.

Also new in MDS 3.0 is the Total Severity Score, a summary of the frequency scores on the PHQ-2 to 9 that indicates the extent of potential depressive symptoms.

TIP: Use PHQ scores to assist with care planning

Total Severity Score can be interpreted as follows:

  • 1-4 = minimal depression
  • 5-9 = mild depression
  • 10-14 = moderate depression
  • 15-19 = moderately severe depression
  • 20-27 = severe depression

Total Severity Score can be used to ensure residents have referrals to the appropriate providers and that non-pharmacological and pharmacological treatments for mood disorder have been investigated.

Further, there may be a PDPM impact on facilities. The depression end split impacts CMG special care high, low, and clinical complexity which may provide revenue of approximately $40 per day per resident.

Recommendations from Polaris

Understanding and assessing resident mood is critical to successful care planning. To prepare for MDS 3.0, facilities should ensure social workers are updated and trained on the new administration of PHQ-2 to 9. Documentation and interview forms should be revised and updated for the new questions and new cue cards will need to be used during the resident interview.

Additional Resources:

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