CMS has released the final draft of the Minimum Data Set, MDS 3.0 version 1.18.11 that must be used for all MDS assessment submissions beginning October 1, 2023. Section G has been entirely dropped. Eleven sections of the MDS form have significant changes. There are also additions to the Care Area Assessment triggers.

LTCS Books has updated books, care plans, care area assessments, and flash drives for the changes, including the MDS Coordinator’s Handbook, Complete Nursing Care Plans book, Director of Nursing Handbook, Restorative Nursing Program, and Social Services Care Plans. The flash drives also include a Free Guide to the Latest MDS Changes in an easy to use chart.

CMS MDS 3.0 RAI Manual Page and Updates

MDS submissions must be made to the Internet Quality Improvement and Evaluation System (iQIES) beginning April 17, 2023. The CMS iQIES system is an internet cloud based program for MDS data submission, survey and certification, and data storage, tracking, and analysis.

Each skilled nursing facility must designate at least two Provider Security Officials available to meet iQIES access requests. CMS has provided articles and videos to make getting started easier:

Create an Account in HARP (HCQIS Access Roles and Profile system, the CMS secure identity management portal)

Register for iQIES Access

New User Checklist and Training Videos

With the ongoing goal to reduce the use of unnecessary antipsychotics, CMS will be conducting audits of schizophrenia coding in MDS data. They will adjust the Nursing Home Care Compare star ratings for facilities whose audits reveal inaccurate coding.

Inappropriate use of antipsychotic medications has been a wide-spread problem in facilities for a very long time, and became worse during and since the pandemic. Past surveys noted in many facilities an absence of comprehensive psychiatric evaluations and behavior documentation. Also, many residents had only sporadic behaviors noted in their medical records, and these behaviors were related to dementia, rather than schizophrenia.

When residents are given erroneous schizophrenia diagnoses, they are subject to poor care and unnecessary antipsychotic medications, both of which can be very dangerous, a recent CMS memorandum stated.

CMS Memorandum Antipsychotic Medications and Schizophrenia

Long term care facilities must develop and implement a baseline care plan for each resident within 48 hours of admission.

The guidelines state the 48 hour baseline care plan must include “the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care,” including, but not limited to: initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASARR recommendation, if applicable.

According to the regulations, facilities may develop a comprehensive care plan in place of the baseline care plan if the comprehensive care plan meets all of the requirements for the baseline care plan outlined in the surveyor guidelines.

In order to assure all of the requirements of the guidelines are met, LTCS Books recommends that the facility develops and implements a comprehensive care plan within 48 hours of admission.

Baseline Care Plan Regulations

Daily COVID-19 reported cases are down 92%, COVID-19 deaths have declined by over 80%, and New COVID-19 hospitalizations are down nearly 80%.

The federal Public Health Emergency for COVID-19 will expire at the end of the day on May 11, 2023, the DHHS stated in a recent memo, and that  they will transition COVID-19 policies, as well as the current flexibilities enabled by emergency declarations, into improving standards of care for patients. Generally vaccines and tests when ordered by a provider will be fully covered without a co-pay. Reporting of lab results and immunizations to CMS will change.

Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap