CMS: Nursing Homes Will Get to Test Out Coding and Train for New MDS System

Nursing homes will have an opportunity to test out coding prior to Minimum Data Set changes slated for October, and receive pre-recorded video training this spring, the Centers for Medicare & Medicaid Services (CMS) shared in an open door forum Thursday.

The videos will deliver foundational knowledge necessary to understand the new items and guidance, Heidi Magladry said during the session. McGladrey serves as the Skilled Nursing Facility Quality Reporting Program coordinator for the federal agency.

Live virtual workshop sessions will be held in late June and early July, she said, and recorded if providers aren’t able to attend.


Listeners said they hoped such training would address concerns on the removal of Section G, and if there would be training related to quality measurement and updates to staffing measures in the Five-Star Quality Rating System.

CMS officials said these questions would be addressed in the future – but not in its spring training videos.

“We will be transitioning our measures later this year. We will be releasing guidance regarding quality measures, and then potentially [plan] any trainings that will arise from that. But we’re still working on that right now,” said Rebecca Natano with CMS.


Within the Minimum Data Set (MDS), Section G is used to measure the functional status of residents. The shift to Section GG pulls rehabilitation services into a separate case mix component, while the old resource utilization groups (RUGs) incorporate it into the case mix with the rest of clinical conditions.

The change from Section G to GG is part of an effort to streamline reimbursement requirements along the care continuum – but it’s still unclear how states will adjust to the switch, and how the change will affect other nursing home processes and tools, including star ratings and state surveys.

CMS will post the final MDS item sets on or about April 1, and data specifications in May, according to Magladry.

CMS posted the draft version of MDS item sets on Dec. 23 and then draft MDS data specifications on Feb. 14 – version 3.01.0.

During the call, quite a few listeners also had questions on adjustments to star ratings, especially related to inappropriate coding within the MDS of schizophrenia and antipsychotic medications in facilities.

The agency in a memo released in January said it would start conducting targeted, off-site audits focused on whether nursing homes are accurately assessing and coding residents diagnosed with schizophrenia.

Inaccurate coding related to schizophrenia could negatively impact a facility’s star rating.

CMS has suggested it would consider lesser action related to star rating changes if a facility self-reported such coding, one caller said. Others urged the agency to look at the role hospitals play in schizophrenia diagnoses.

“Perhaps CMS could look at the hospital programs who, when elderly patients come into the hospitals, they’re automatically given an antipsychotic because they’re agitated or confused about being there, then they come to the nursing homes,” Mary Gracey-White, registered nurse and director of regulatory compliance for the Greater New York Health Care Facilities Association, said during the call. “That’s the point at which some of this starts.”

Agency staff said they were aware of these challenges on the hospital side – and plan to take feedback into consideration.

CMS officials on the call suggested operators contact the behavioral health division of CMS with these questions at [email protected].

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