Oct. 1, 2025: What Nursing Homes Need to Know

(Sept. 29, 2025) There have been a number of Centers for Medicare and Medicaid Services (CMS) data collection releases for 2025, and some go into effect Oct. 1, 2025. The information below will help nursing home members be prepared:

Minimum Data Set (MDS) 3.0 version 1.20.1 Resident Assessment Instrument (RAI) and associated item sets are to be used for assessments with reference dates beginning Oct. 1, 2025. Download the Long-Term Care Facility RAI 3.0 User’s Manual version 1.20.1 along with change tables and item sets here. For a summary of all of the changes to the RAI Manual, there is a Track Changes section on pages 863-1,001.

CMS also released an updated ZIP file containing files that include changes to Claims and Skilled Nursing Facility Quality Reporting Program (SNF QRP) measure materials that go into effect Oct. 1, 2025. That file can be downloaded here.

File contents summary:

1. The MDS 3.0 Quality Measures (QM) User’s Manual v17.0 contains detailed specifications for the MDS 3.0 QMs. This was effective Jan. 1, 2025. No changes have been made to this document since its release. CMS has delayed the release of the updated Long-Stay Antipsychotic Medication Use QM until the January 2026 Care Compare refresh. An updated QM Manual is anticipated prior to that refresh.
2. The Risk Adjustment Appendix File for the MDS 3.0 QM User’s Manual accompanies the MDS 3.0 QM Manual v17.0 and contains the logistic regression coefficient values used to calculate the risk-adjusted QMs. There are no coefficient changes to the Risk Adjustment Appendix File.
3. The Claims-based QM Technical Specifications Update June 2025 contains detailed technical specifications for all Nursing Home Claims-based QMs. The changes are in the MDS covariates and consist of replacing Section G items with Section GG items and were used to calculate the QMs at the July 2025 Care Compare refresh.
4. Nursing Home Compare QM Technical Specifications Appendix (APPENDIX – Claims-based measures Technical Specifications updates June 2025 containing risk adjustments and coefficient values) contains tables and appendices related to the Nursing Home Compare Claims-based QMs. Changes to the appendices consist of:
   1. For the measures Short-Stay Residents who were Re-hospitalized after a Nursing Home Admission and Short-Stay Residents who have had an Outpatient Emergency Department Visit: The model is based on all SNF stays with admission from a hospital for calendar year (CY) 2024.
   2. For the measures Hospitalizations per 1,000 Long-Stay Resident Days and Outpatient Emergency Department Visits per 1,000 Long-Stay Resident Days: The model is based on all days for CY 2024 that residents were in the nursing home after they attained long-term resident status (i.e., after 100 cumulative days in the facility).
5. The SNF QM User’s Manual v7.0 contains detailed specifications for all SNF QRP QMs effective Oct. 1, 2025. Three measures – Discharge Function Score, Discharge Mobility Score, and Discharge Self-Care Score – had changes to their covariate section that consist of “No physical or occupational therapy at discharge” (MDS items O0425B and O0425C), related to MDS v1.20.1 only collecting that data on discharge assessments.
6. The Risk Adjustment Appendix File for the SNF QM User’s Manual v7.0 contains coefficient values used to calculate the risk-adjusted QMs.
7. The Imputation Appendix File for the SNF QM User’s Manual v7.0 contains imputed coefficients used to calculate the risk-adjusted Discharge Function Score measure.

Contact: Susan Chenail, schenail@leadingageny.org, 518-867-8383 ext. 116