The Centers for Medicare & Medicaid Services (CMS) released a draft Minimum Data Set (MDS) on Tuesday, and while the changes are minimal, clinical and reimbursement experts noted that they could lead to reduced control over certain quality reporting measures. However, the earlier-than-anticipated release also suggests that the federal agency aims to give operators a better sense of direction on upcoming changes, and the draft does contain several useful additions.
“This is a really early release. They want us to get a head start,” Joel VanEaton, executive vice president of post-acute care regulatory affairs and education at Broad River Rehab, told Skilled Nursing News. “After the talking session CMS had regarding including all payers in the SNF QRP, I would not be surprised to see more changes coming in the rulemaking cycle next year,” VanEaton said.
The draft MDS was released following a listening session on the Skilled Nursing Facilities Quality Reporting Program (SNF QRP) on the same day, during which the federal agency proposed the possibility of gathering more quality data and extending it to all payers, not just Medicare.
Some useful additions
While the new MDS drafts indicate “nothing super surprising” overall, VanEaton said it was important to note several helpful additions.
For example, a new Section R contains the finalized social determinants of health (SDOH) items related to the living situation, with two questions on the food category as well as on utilities and a revised transportation item, he said.
“I think this section will expand over time with more SDOH-related items,” said VanEaton.
Moreover, Section O has been revised to eliminate therapy minutes and days as finalized in the fiscal year 2025 rule, a move that VanEaton applauded.
“This is helpful,” he said of section O. “CMS will need to update the technical specifications for the D/C function score quality measure related to this change,” he said.
Another useful addition in several item sets is to section I, the section that pertains to active diagnoses, VanEaton said, noting that the new item I7900 will enable clinicians to select a box indicating “None of the above active diagnoses within the last 7 days.”
Clues to CMS direction
The changes are small, but give insights into the direction that CMS wants to take for future modifications with regards to the Resident Assessment Instrument (RAI) manual, according to Veronica James, vice president of clinical reimbursement at Health Dimensions Group (HDG).
Federal regulators want to track medications that the Food and Drug Administration (FDA) hasn’t approved for a certain use, a practice known among clinicians as “off-label use.”
“The changes to the RAI for Oct. 1, while minimal in number, sheds some light on where CMS is headed,” she said.
Now, CMS might require that off-label anticonvulsant use be tracked, James said.
“To track for [such] medications is furthering the agenda of [a more] appropriate use of medications in our senior populations,” James said. “The off-label use of these classifications of medications has proven to be detrimental in the geriatric population with dementia in some cases.”
CMS has also added in COVID vaccination tracking for nursing home residents, James noted. And while this requirement is similar to that for pneumococcal vaccines, CMS is not looking at any reasons why the COVID vaccination was not given, such as if the resident refused or if they were medically ineligible.
The absence of this information for the vaccine could impact scores for quality reporting.
“This is something to watch for in the future as it may impact the quality review program measures in situations where SNFs have little control over the outcome,” James said.