Minimum Data Set (MDS) changes for 2024, along with updates to nursing home surveys were top of mind among representatives of the Centers for Medicare & Medicaid Services on Thursday, as the agency outlined its plans for next year in an Open Door Forum.
CMS plans to release the MDS 1.19.1 in early 2024 with specifications going into effect Oct. 1 of that year, according to Heidi Magladry, Skilled Nursing Facility Quality Reporting Program coordinator for CMS.
The agency says the upcoming revisions to MDS will be small, with three changes involving anticonvulsants, self-care and mobility, and Covid vaccination status for residents. Operators can also expect the final draft of the MDS error message guide tentatively by the end of the month, according to Kim Jasmin at CMS’ Division of Quality Systems for Assessments and Surveys.
The error message guide is still under review by CMS due to the numerous changes that were effective Oct. 1, 2023, she said.
“As always, CMS provides draft versions of item sets and other documents in order for review and feedback from our stakeholders,” said Magladry. “Having other eyes and views from different entities helps improve the clarity of language to ensure accurate coding. We encourage stakeholders to view the posted draft materials and provide feedback to us as we find it very helpful.”
And finally, CMS officials also shared that the federal agency will test new survey processes to facilitate a timely completion of surveys at high risk nursing homes.
MDS changes for 2024
Anticonvulsants will be added to the high risk drug class in Section N, since such medications are being administered to residents. They often carry certain benefits and risks, Magladry said, but are not included in the MDS currently.
The self care and mobility discharge goal column in Section GG – GG-0130 and GG-0170, column two – will be removed next year.
Lastly, a new item will be added to collect Covid vaccination status among residents. The data will be used to inform the “Covid vaccine percent of patient residents who are up-to-date” measure for the SNF Quality Reporting Program (QRP).
The last two changes are the result of policies finalized last year in the fiscal year 2024 Skilled Nursing Facility Prospective Payment System Final Rule, noted Magaladry.
“It’s important that resident care plans are developed while considering medications that can impact their outcomes and risk,” added Christina Teague at CMS’ Division of Nursing Homes within.
On a more technical note, CMS health insurance specialist, Ellen Berry, said the Internet Quality Improvement & Evaluation System (iQIES) MDS user interface has been replaced by jRAVEN software. The new interface doesn’t allow for completion of MDS assessments for other insurance payers including Medicare Advantage and private insurance, or for other purposes.
“The take home message is that providers who need to complete assessments for other purposes, other than federal and state, should use vendor software. Providers are not to submit these assessments to IQIES,” said Berry,
Survey testing in the coming months
Debra Lyons with CMS also spoke briefly about upcoming nursing home survey testing due to take place over the next several months. Specifically, CMS will test new survey processes to help surveyors complete surveys more efficiently in limited instances where the risk of resident harm is demonstrated to be lower, she said.
The agency hopes this change will help surveyors conduct more surveys where the risk of resident harm is higher – along with addressing the survey backlog.
“Over the last few years, we have looked for ways to improve the consistency, accuracy and efficiency of the nursing home survey process within the context of increasingly constrained survey resources,” Lyons said on the call.
Nursing home operators may see additional survey staff on site, along with changes to how some of the investigations are conducted, she said. More information will be available next year.
The largest revision to the survey process happened in 2017, she said, when states were migrated over to a new standardized survey process.
It’s becoming increasingly urgent that surveys are conducted in a timely manner at high risk nursing homes as CMS deals with a backlog of surveys caused by the pandemic. Increases in complaints and a “flatline survey and certification budget” for the last 8 years have also spurred survey testing, Lyons said.
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