CMS has been busy releasing updates that are impacting SNFs in the immediate future. Sharing three below that were announced last week.
Nursing Home Care Compare “Temporary Pause”
- CMS announced Friday, August 15th that Nursing Home Care Compare has been frozen
- There will not be a Five-Star rating provider preview report for August 2025 as information will remain static using July 2025 Care Compare Refresh
- The pause will provide time for “data integrity validation” following the move from the old QIE system to the cloud-based iQIES (Internet Quality Improvement and Evaluation System)
- Updates expected with the October 2025 refresh
- For additional information please refer to CMS memo #QSSAM-25-03-NH
Skilled Nursing Facility Random Data Validation Process: VBP and QRP Potential Impactor of 2% Annual Payment Update
- Data Validation Process = MDS accuracy assessment of measures used in the Value Based Purchasing (VBP) and Quality Reporting Programs (QRP)
- Scheduled to begin fall of 2025 (within the next few weeks)
- Facility selection will be random and SNFs can only be selected once in a calendar year
- SNFs will be notified of their audit selection through their iQIES system in the MDS 3.0 Provider Preview Reports folder
- Notification is labeled “Skilled Nursing Facility Data Validation Process – Initial Selection Notification” – this will be followed by a second notification
- The list of sample residents (up to 10) with very specific instructions for submission of medical records will be included in the folder
- Submission through use of a secured portal is required within 45 days of initial selection notification
- Records must be submitted in a PDF format – no other will be accepted (NO SS# or Face Sheet)
- Scoring of audit results will be located via iQIES within 3 months following medical record submission
- Results are for informational purposes only; “SNF’s are not penalized for their validation results”
- Noncompliance may result in a 2% reduction of a SNFs Annual Payment Update for FY 2027 SNF QRP program year
- Noncompliance notification will come through a notification letter from the MAC
- Questions about this program can be directed to snfvalidation@hcmsllc.com Mon-Friday 8:00AM to 6:00PM ET
- This information has been taken from CMS’ FAQs created August 2025
CMS Released Final MDS 3.0 Item Sets, Effective October 1, 2025 (Announced August 15, 2025)
- The final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.20.1v3 and Item Matrix v1.20.1v3 are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page
- Significant changes include removal of therapy items in Section O, replaced with questions surrounding which therapies were delivered at least 15 min per day in the previous 7 days
- Four Social Determinants of Health were also removed from section R pertaining to living situation, food, and utilities
- Final RAI manual release anticipated later this year
The Point Is: In the midst of many states undergoing Medicaid reimbursement model changes, CMS dropped these additional announcements. At a time when resources are stretched thin adapting and shifting to new processes, team members will also need to be made aware of these recent announcements, specifically MDS coordinators and organizational leaders who are keenly aware of the 5-star reporting releases, 2% Annual Payment Updates and MDS accuracy.
