Here’s what to know ahead of October’s MDS changes
The cool, crisp air of September brings welcome relief from sweltering summer weather. The same could be said of the upcoming MDS changes. When MDS version 1.19.1 goes into effect Oct. 1, you’ll see that compared to 2023, CMS has scaled back substantial changes and that this year’s updates are dramatically smaller than last year’s.
Although this year’s changes are smaller, it’s still important to stay up to date to ensure you’re receiving maximum reimbursement and to make sure you’re in a good position for bigger changes likely to come next year. Here are three main areas that will be changing on Oct. 1:
- Section GG: Self-care and mobility
CMS has eliminated discharge goal collection in section GG. Removing an MDS item is uncommon for CMS, so this most likely indicates a shift in focus toward the discharge outcome metric.
- Section N: High-risk medications and indications for use
CMS added a new item for collecting information on the use of anticonvulsant medications. Following their increased scrutiny of anti-psychotics in the elder population over the past year or so, it makes sense that they are also increasing their focus on anticonvulsants. Use of these medications will be a critical factor in future assessments and reporting. Facilities should closely review their anticonvulsant use and make sure providers have appropriate diagnoses and rationale for prescribing them, keeping in mind that anti-psychotic behaviors should not be a reason for their use.
- Section O: Immunizations
CMS has added an item on resident COVID-19 vaccination status. The new question requires only a “Yes” or “No” answer, making it easier than the more detailed flu and pneumonia vaccination questions that collect dates and reasons for non-vaccination. CMS is also proposing, as of Jan. 1, 2025, to increase the amount of required reporting for other illnesses such as flu and RSV. This may indicate a trend toward more comprehensive data collection in the future. Changes of this nature inevitably tie into future quality metrics and reimbursement rates.
Get ready for 2025
After the relatively minor changes this year, MDS’ focus moving into 2025 will shift to how states are managing the implementation of the patient driven payment model (PDPM). As of Oct. 1, 2025, states will no longer be able to use RUGs and the OSA. On that date, CMS will replace the current case mix model, RUG-IV, with PDPM.
Providers and vendors alike have been voicing concerns about state reimbursement models, lagging implementation timelines, lack of information sharing and the impact of these changes on facility operations. And because each state has autonomy for how and when to comply, this means facilities need to proactively plan and adapt to the new model.
It’s important for providers to stay informed and be prepared for upcoming changes from CMS. MatrixCare experts are already keeping a close eye on various states as they make this transition. We’ll be ready to keep you informed about how future changes may affect your facility and to help you make sure changes are seamless for users.
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Jenny Lee
Jenny Lee is a health care regulatory expert with more than 15 years of experience. After working for the Brookings Institution and various specialty medical organizations, including ASCRS and the National PACE Association, she joined MatrixCare as its Regulatory Compliance Manager, to ensure that all its technology solutions remain compliant in the ever-changing health care market. She is excited by MatrixCare’s continuous opportunities for innovation to support patients and providers in the long-term care space.
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