CMS Releases Draft MDS Item Sets and RAI Manual (SNF)

This week, the Centers for Medicare & Medicaid Services (CMS) released the final Draft MDS Item Sets version v.1.18.11, along with the updated Draft RAI Manual. These items comprise the long-awaited release that becomes effective October 1, 2023. 

Substantial revisions were made to both the Item Sets and the RAI Manual. 

• In particular, a focus on the resident’s voice has been incorporated, with Section A providing additional options about race and origin. Discharge planning has been expanded and now factors in the resident’s abilities to make appointments or obtain their medications, as well as their access to transportation. Items in Section Q “Participation in Assessment” are also centered on the resident’s voice and goals.
• Section G “Functional Abilities” is being eliminated from the MDS with Section GG “Functional Abilities and Goals” taking its place. This change alone will require facility planning to meet the expectations that “an interdisciplinary team of qualified clinicians is involved in assessing the resident during the three-day assessment period.” All documentation must support a resident’s need for Part A SNF-level services and corresponding expected and actual response to those services.
• Most of the Quality Measure data pulled from Section G in the past will transition to the revised Section GG responses. 
• In addition, nutritional approaches have expanded from two to four options. The facility will report if the approaches were in place upon admission, which is considered days one through three of the stay, performed while not a resident, performed within the last seven days while a resident, and at discharge.
• Other changes include Section N “Medications Received” being renamed “High-Risk Drug Classes: Use and Indication.” Members will want to assure that all high-risk drugs have a documented indication for use. Drugs considered high-risk for MDS purposes include medications such as diuretics, hypoglycemic, antibiotic, as well as antipsychotics, antianxiety, and opioids. Likewise, special treatments, procedures, and programs were reformatted and require more specific documentation in the medical record as well.

Webinar: CMS will cover the MDS changes at the next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum, on April 13, 2023, at 2 pm ET. To participate by phone, call: 1-888-455-1397 and use Conference Passcode: 4325849.

More to Come: Watch for coming educational programs offered by both HCAM and AHCA with specific training on the new changes.