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MDS Changes are Coming: What You Need to Know

September 25, 2023
September 25, 2023

This blog is taken from a recent HealthStream webinar entitled “MDS Changes are Coming: What You Need to Know.” The webinar was moderated by Caroline Acree, Senior Marketing Manager and featured Tracy Cooley, RN, BSN, Senior Success Manager.


MDS Changes – Overview

The Centers for Medicare and Medicaid Services (CMS) has released the final version of the Minimum Data Set (MDS) 3.0 version 1.18.11 for implementation on October 1, 2023. This update includes some of the most significant changes seen in the last ten years and have a far-reaching impact on reimbursement, regulatory, compliance, quality of care, and more. So, with the release of the final version of the MDS 3.0 version 1.18.11 going into effect, what do healthcare leaders need to know to prepare?


What is New?

Cooley began by describing these changes as the most significant changes to the MDS in over a decade. There are 29 revised data elements with the goal of achieving standardized reporting across a variety of post-acute settings such as skilled nursing facilities, home health, inpatient rehabilitation centers, and long-term care hospitals. 

Some additional changes were made as a result of the Impact Act which was developed by CMS to facilitate the exchange of information across post-acute care settings and other providers. There will be six new Standardized Patient Assessment Data Elements (SPADEs) to be collected on admission and discharge including: ethnicity, health, literacy, language, race, social isolation, and transportation measures.


What to Expect

Leaders should plan to address changes in the following areas:

  • Operations: The increase in MDS items will result in an increased workload including the initial learning curve due to additional coding. In addition, this could impact revenue. Frontline staff will spend more time on documentation, and MDS policies will need to be updated. The MDS Coordinator will need additional training to ensure that the MDS assessments are completed in a timely and accurate manner.
  • Technical Requirements: The MDS now includes requirements on how the Transfer of Health (TOH) measures are provided to health entities such as skilled nursing facilities, home health providers, etc. When transmitting health information to a resident or responsible party, their preferred means of communication and learning style must be considered, including any hearing or visual limitations.
  • Reimbursement: The new MDS items are required to meet the Skilled Nursing Facility Quality Reporting Program (QRP) compliance requirements. Should an organization fail to meet those requirements, it will result in a 2% reduction in Medicare Part A reimbursements for a full fiscal year. In addition, the accuracy threshold for MDS reporting will be raised from 80% to 90%. Miscoding MDS data can result in missed opportunities for reimbursement.
  • Person-Centered Care Planning: Nursing facilities will need to document resident-specific assessment data based on issues identified by the MDS. Decisions will need to be made on how resident data on language, transportation and literacy needs (among others) will be collected and documented. The active participation of the resident is essential on measures such as assessment for loneliness, isolation, the ability to make medical appointments, and obtain medications.
  • DEI and Social Determinants of Health: These can have a huge impact on outcomes and there is now an opportunity for more granularity in reporting ethnicity and race. In addition, gender-neutral language has been added. Health literacy will be documented along with language barriers to improve resident’s ability to understand and follow treatment plans.
  • Quality Measures: MDS changes will impact the Five Star calculations. The removal of Section G makes the acuity adjustment to staffing star rating obsolete.
  • Survey Compliance: Some residents selected to participate in the annual survey process will be selected based on the MDS indicators. Correct coding is important as coding errors can result in a survey citation.


What’s Next - Strategy

Cooley recommends that skilled nursing facilities begin to address the changes now and shared the following recommendations.

  • Begin by auditing your current MDS processes to ensure that there are no inefficiencies or resource gaps.
  • If any inefficiencies or resource gaps are identified, conduct root cause analysis and then develop and implement appropriate interventions.
  • Create outcome and process measures to determine the effectiveness of any interventions.
  • Develop a plan for ongoing monitoring to ensure compliance.
  • Focus on training staff to ensure accurate MDS coding to avoid missed reimbursement or survey citations.
  • Support the organization’s MDS coordinator with time, training and resources.

The most significant changes to the MDS in the last decade will go into effect on October 1st. Due to far reaching impacts of the MDS process, leaders need to prepare now. Contact HealthStream today to learn more about how to meet these new requirements.