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The Centers for Medicare & Medicaid Services kept a pre-New Year’s resolution by releasing a second draft of the new MDS tool that will be used to assess residents starting Oct. 1, 2023.

The agency released a complete Minimum Data Set 3.0v1.18.11 item sets on Dec. 23, after unveiling only the comprehensive data set in September.

“CMS also included a change document that is a cross check showing which MDS items are contained in each item set,” noted Joel VanEaton, executive vice president of PAC Regulatory Affairs and Education with Broad River Rehab. “This is important since this is the first time we have been able to view the complete set of item sets.”

VanEaton also feels more changes may be forthcoming through proposed and final rules in the fiscal 2024 rule-making cycle.

“It is interesting that the link and downloadable ZIP file are still labeled as a draft while the individual item sets are not labeled as drafts,” VanEaton said in an email to McKnight’s Long-Term Care News. “These indicate the following in the footers, ‘Effective 10/01/2023.” Perhaps more revisions to come through the proposed and final rulemaking cycle for FY 2024.”

CMS did not respond to a McKnight’s inquiry Tuesday about the possibility and timing of more changes.

VanEaton explained that the new draft reflected “minor clerical and/or instructional revisions” to items A2121, A2123, D0160, GG0130 Admission, GG0170 Admission, GG0130 Discharge, GG0170 Discharge, GG0130 OBRA/Interim, GG0170 OBRA/Interim. A complete rundown appears in a blog post he wrote on the topic.

He was among the industry professionals expressing impatience in December with the flow of new MDS materials. After CMS surprisingly and quietly released a draft of new MDS specifications on Sept. 2 — the Friday before the long Labor Day weekend — skilled nursing leaders had not seen anything further for more than three months.

VanEaton predicted less than four weeks ago that providers would not have enough time to adapt to the changes by their Oct. 1 implementation date. MDS data triggers reimbursement rates for Medicare patients.

The changes also are expected to create residual effects in areas affected by the MDS, such as Care Area Assessments, quality measures and Five-Star ratings. Software developers also must get up to speed with any final changes.

Despite the release of more information before the end of 2022, as CMS had vowed, some experts were still expressing frustration with the pace of progress. 

An Oct. 1 start date “seems pretty close, with all the information and training pending release,” said Alicia Cantinieri, vice president of MDS policy and education for Zimmet Healthcare Services Group, in an email to McKnight’s Tuesday.

Calling the most recent MDS draft issuance “a December gift,” Cantinieri, reminded that CMS said it would release final versions of the new MDS item sets in “early 2023.” The agency also said last month that it hoped to release the corresponding new RAI manual during the second-quarter of 2023.

“This feels like receiving the gift of a new bike as a child, except that it isn’t assembled, and the instructions will be shipped separately in six months,” Cantinieri said.

She said she also would not be surprised to see more changes coming.

“It is possible that there may be more revisions to come with the FY 2024 proposed and final rule, especially if there are to be changes to Medicare Part A PDPM related to the new MDS version/questions. However, this is unknown at this point,” she told McKnight’s

She also said that until the RAI Manual is released, providers won’t know whether any of the item coding instructions will change. 

There are also “many unanswered questions” related to the new version and the elimination of the current MDS section G on the OBRA assessments, such as how the quality measures that use section G will be calculated and how the staffing component to Five-Star will change, she added.