What is Changing?
Key updates to the MDS 3.0 QMs include the following:
- Re-specification of Percent of Residents who Received an Antipsychotic Medication (Long Stay) Measure. This measure has been re-specified to include Medicare and Medicaid claims and encounter data, in addition to MDS data. The measure re-specification will be effective beginning January 1, 2026.
- Changes to risk adjustments for the Discharge Function Score Measure due to Retired Therapy Items on the MDS. Items O0400B and O0400C were retired from the MDS 3.0 and the discharge item O0425 was added to the MDS 3.0 effective October 1, 2025. For this measure, the risk adjuster ‘no physical or occupational therapy’ will be determined using the new discharge assessment item for the overall risk-adjustment model and for the statistical imputation procedure.
The re-specified long-stay antipsychotic medication measure will begin public reporting on Care Compare on Medicare.gov in January 2026 and will use 07/01/2025 - 09/30/2025 (Q3 2025) as the initial data collection period. Subsequent updates will follow a quarterly schedule. Resident-level quality measure results will also be provided in iQIES.
What can providers do to prepare?
- Monitor your Five-Star Preview reports when available on iQIES. The preview report for the January refresh should be available around the 3rd week of January 2026 and will provide you with the measure calculation prior to public posting.
- Ensure ICD-10-CM codes are kept up to date in the electronic medical record. The updated antipsychotic medication measure adds claims data (including ICD-10-CM codes) to validate diagnoses.
- Pull and review your QM package reports in iQIES to validate accuracy of data. This information may be used to conduct chart audits and make corrections if necessary.