Upcoming modifications to the Minimum Data Set (MDS) effective October 1 will substantially influence nursing home five-star ratings.
The Centers for Medicare and Medicaid Services (CMS) has made significant changes to the Minimum Data Set (MDS) 3.0 assessment, effective October 1, 2023. These changes will impact Five-Star reporting for both Quality Measure (QM) ratings and Staffing ratings. The changes include the removal of section G used to calculate activities of daily living (ADL) scores, which will affect the QM rating and Staffing rating reported on the Care Compare website.
The changes will also impact the Five-Star Staffing Rating. Providers use the Payroll-Based Journal (PBJ) system to report actual staffing levels to CMS, which are then case-mix adjusted for acuity prior to calculating staffing rating points. The case-mix adjustment methodology has been updated to use a similar approach based on the Patient-Driven Payment Model (PDPM) Nursing Case-Mix Group (CMG). Additionally, revisions to the staffing rating thresholds have been made to ensure that the distribution of points remains unchanged.
The changes will also impact several Quality Measures (QMs), including short-stay and long-stay measures. The Residents Who Made Improvements in Functions short-stay measure will be replaced with the Discharge Function Score measure, while three long-stay QMs will be reformatted to replace section G data with equivalent section GG data. Reporting on these new measures will begin in January 2025. CMS has provided additional guidance and resources on these changes, including updated technical user guides and measure calculation manuals.
The article also notes that CMS-672 forms completed for survey purposes will no longer require the completion of fields using section G data as of September 29, 2023. The remainder of the form will still be completed until October 22, 2023, when these fields will be moved to CMS-671 and CMS-672 will be discontinued.
Overall, these changes aim to improve the accuracy and reliability of Five-Star reporting for nursing homes. However, they may require significant updates and adjustments from providers to ensure compliance with the new requirements.