American Therapeutic Recreation Association


Brief Overview of MDS 3.0 and Recreation Therapy

Nancy E. Richeson, PhD, CTRS and Sharon Nichol’s, CTRS/L

MDS 3.0

The MDS 3.0 is a standardized assessment for facilitating care management in nursing homes (NHs) and non-critical access hospital swing beds (SBs). This version is based on a need for resident centered care - encouraging the residents to speak for themselves, focusing on resident needs, therefore promoting a change in culture in long-term care. 

MDS 3.0 has been designed to improve the reliability, accuracy, and usefulness of the MDS, to include the resident in the assessment process, and to use standard protocols used in other settings. These improvements have profound implications for NH and SB care and public policy. Enhanced accuracy supports the primary legislative intent that MDS be a tool to improve clinical assessment and supports the credibility of programs that rely on MDS ( Why Resident Voice?  CMS’s goal is to increase resident-centered care by respecting the individual’s voice. This is fundamental to high quality and a changing culture.  Residents and families want care to be individualized and accurate. The MDS 3.0 improves accuracy, feasibility, and efficiency. General, unfocused questions do not elicit meaningful reports. (Rand, 2008)

Section O

Recreational Therapy is included in Section O. which includes other rehabilitative therapies (Physical Therapy, Occupational Therapy, Music Therapy and Speech Therapy). As a result of this inclusion Recreational Therapy is considered a rehabilitation option for Medicare eligible residents. Recreational Therapy interventions will be calculated in minutes, days, and weeks depending on the physician’s orders. The physician’s orders need to include the start and stop dates of the intervention. Documentation of Recreation Therapy interventions can be found under the subheading 0400(F).

While Recreational Therapy is currently not a Medicare covered (reimbursable) service we have the opportunity to impact the RUG scores affecting the level of Medicare coverage  down the road if we record minutes/days/weeks now! At this time we are included in the “bed rate”. Your MDS 3.0 minutes will be vital for future coverage.

Assessment in Long-Term Care based on MDS 3.0

Buettner Assessment of Needs, Diagnoses and Interests for Recreation Therapy in Long-Term Care (BANDI-RT).  This assessment is designed to follow the MDS 3.0 and to help the practicing recreation therapist review all relevant areas of function and design a RT Care Plan. The minutes and days of RT should be documented in Section O for eligible residents.


Buettner Assessment of Needs, Diagnoses and Interests for Recreation Therapy in Long-Term Care (BANDI-RT).  University Of Southern Maine Retrieved January 17, 2014

Buettner, L. MDS 3.0 Section O: An update for certified therapeutic recreation with Medicare patients. Retrieved January 17, 2014

Buettner, L. MDS. 3.0: Implications for recreation therapy. Retrieved from

Buettner, L., Legg, T. Recreation therapy and MDS 3.0. Long Term Care Living. Retrieved January 17, 2014

MDS 3.0 for Nursing Homes and Swing Bed Providers. Centers for Medicare and Medicaid Services. Retrieved January 17, 2014

Nursing Home Quality Initiative Center for Medicare and Medicaid Services. Retrived January 17, 2014

Rand Health, “The MDS 3.0: Improving Assessment”, Special Open Door Forum, January 24, 2008.

Re-Creative Resources Inc. MDS News. Retrieved January 17, 2014 from