MDS Item Set to Expand

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 The proposed rule for fiscal year 2016 Skilled Nursing Facility (SNF) Prospective Payment System was posted April 20 by CMS. In the proposed rule are plans to expand the Minimum Data Set 3.0 (MDS). The target date is Oct. 1, 2016 for implementation of new or refined MDS coding items. The rule also highlights steps CMS is taking to move toward a value-based Medicare payment system.

CMS will add or refine coding questions on the MDS item set to comply with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The IMPACT Act mandates that CMS develop a quality reporting program to capture outcomes of care for payment.

Beginning in FY 2018 (Oct. 1, 2017) Payment determinations will be related to three quality domains: functional status, skin integrity and incidence of major falls. The proposed rule summarizes the planned QMs that will be used for cross-setting measurement in developing the value-based payment system:

  • The proposed quality measure addressing skin integrity, Percent of Residents or Patients with Pressure Ulcer That Are New or Worsened (Short Stay).
  • The proposed quality measure addressing the incidence of major falls: Residents Experiencing One or More Falls with Major Injury (Long Stay).
  • The proposed quality measure addressing functional status, cognitive function and changes in function and cognitive function is:  Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function.

CMS indicates that FY 2017 (Oct. 1, 2016), will adopt a new cross- setting QM for functional status, and they plan to add additional coding items to MDS section G.  CMS also proposes to base the new section G items on the CARE item set’s functional status items.  These items would capture residents’ functional status on the six-level scale at admission, to indicate the goal of the plan of care, and at discharge from the facility.  The functional score at discharge would be compared to the admission score and the care-plan goal score to determine outcomes of the care episode.

For unplanned discharges, only the admission score and functional goal score will be reported.  The discharge functional status will not be required.

The upcoming fiscal year’s MDS changes state that the ICD-10 diagnoses coding system will be implemented on Oct. 1, 2015.

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