CMS has released the updated RAI Manual, effective October 1, 2025. Any previously downloaded copies need to be replaced with this final version to avoid confusion, as several notable changes were made.
Top 3 Changes to Watch:
- Falls & Major Injury Redefined – Broader criteria will likely impact Quality Measures, requiring stronger documentation.
- Therapy Coding Simplified – Therapy services now use check-box coding instead of days/minutes (except Part A).
- New Guidance on Medications – Facilities are encouraged to use one consistent resource for pharmacological classification.
Section Highlights You Should Know:
Section A – Demographics & Transportation
- All references to “Gender” changed to “Sex.”
- Transportation item renumbered from A1250 → A1255, with new numeric response codes.
Section D – Mood
- New guidance for PHQ-2 to 9 frequency coding. A dash may be used in rare cases when residents can provide that the symptom is present but cannot provide frequency.
Section GG – Functional Abilities
- Added a new “Performance Coding Tips” section.
- Several coding examples were removed.
Section J – Falls & Injuries
- Definition of a fall now includes injuries caused by external forces (e.g., one resident pushing another).
- Major injury definition expanded:
- Now includes traumatic fractures, joint dislocations/subluxations, internal organ injuries, amputations, spinal cord injuries, head injuries, and crush injuries.
- Clarification: pathologic fractures are not coded as major injuries from falls.
- This broadened definition will likely impact Quality Measures; facilities will need precise documentation.
Section K – Weight Changes
- Clearer examples provided for coding weight loss/weight gain.
Section M – Pressure Injuries
- New coding guidance for unstageable pressure injuries that change classification after admission.
Section N – Medications
- CMS suggests using one consistent resource (e.g., package insert or pharmacist input) for determining pharmacological classification.
Section O – Therapy Services
- Therapy services now coded via checkboxes instead of days/minutes (except Part A therapies, which remain unchanged).
Chapter 5 – MDS Corrections
- Updated process for Correction, Deletion, and Move Requests through iQIES, with new steps and decision tree.
The Point Is: At a time when survey scrutiny and reimbursement pressures are already high, MDS coordinators, clinical leaders, and interdisciplinary teams must stay aligned and proactive to ensure accuracy, protect outcomes, and avoid compliance risk. QRM is here to help you navigate these changes with clarity and confidence.
