The Centers for Medicare & Medicaid Services (CMS) on Friday released a draft version of the Minimum Data Set (MDS) with four Section R items removed.

In the prospective payment system (PPS) proposed rule for skilled nursing facilities (SNFs), released last month, CMS floated the removal of these MDS items, which assess elements related to patients’ social determinants of health (SDOH) – specifically, information related to their living situation, food and utilities.

However, that PPS rule has not yet been finalized.

The move to release this draft version of the MDS with Section R removed is perplexing, given that the proposed rule is still in its public comment period, said Joel VanEaton, EVP of PAC regulatory affairs and education at Broad River Rehab.

“This is the first time I can remember when CMS posted material like this that has been proposed but not finalized,” VanEaton told Skilled Nursing News in an email. “I’m perplexed. I personally know of commenters that will be submitting comments in favor of Section R. Does CMS presume no one will comment in favor of it, or do they believe those types of comments have no merit?”

CMS had not replied to Skilled Nursing News’ request for comment as of the evening of Monday, May 26.

In the PPS proposed rule, CMS stated that removing the four items would lessen the associated burden on providers, estimated to be 31,791.20 hours of administrative burden at a cost of $146.11 per SNF.

Instead, the agency would “work towards the workflow for these data elements being part of a low burden interoperable electronic system.”

But VanEaton expressed frustration at the way in which CMS has proceeded.

“It’s presumptuous of CMS to have posted 3 versions of the data set so far, along with a draft of the RAI Manual that contains Section R, and assume that somehow providers will give credence to v3 of the data set before the final rule is complete,” he wrote. “It is perplexing to me that CMS spent so much ink in the FY 2025 rule making cycle substantiating the need for these items in the MDS and to finalize their implementation only to turn around and propose to remove them before Section R has even been implemented.”

Noting that the RAI manual and the FY 2027 SNF QRP [Quality Reporting Program] table for reporting measures data will be revised if the Section R removal is finalized, VanEaton said he is taking a wait-and-see approach.

“Personally, I will be waiting until the final rule is posted later this summer to believe that Section R will actually materialize or not,” he wrote.