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CMS Changes Antipsychotic Medication Quality Measure in 2026 Using Hybrid Data

As of January 2026, the Centers for Medicare & Medicaid Services (CMS) will add a new method for capturing antipsychotic medication use among long-stay residents in skilled nursing facilities.
In addition to MDS-based data from section N, CMS is now using claims data to identify antipsychotic use. Because of this expanded data set, some facilities may notice an increase in their long-stay antipsychotic quality measure.
For instance, if a medication like prochlorperazine — commonly ordered for nausea — is omitted from the MDS due to a lack of awareness that it is classified as a first-generation antipsychotic, it will now be captured for the quality measure through Part D claims.
Effective January 2026 this change will be reflected in the Care Compare.gov publicly reported data. Review the revised Quality Measures User’s Manual for Long Stay Antipsychotic Measures.

Skilled Nursing Facility Data Validation Process

The Skilled Nursing Facility data validation process assesses the accuracy of Minimum Data Set (MDS)-based quality measures used in the SNF Value Based Purchasing (VBP) and Quality Reporting Programs (QRPs). The SNF data validation process has been established in response to Section 1888(h)(12) of the Social Security Act that requires the Secretary to apply a data validation process to SNF VBP and QRP measures. In the SNF Prospective Payment System (PPS) fiscal year (FY) 2024 final rule (CMS 1779-F) and FY 2025 final rule (CMS-1802-F), CMS specified that a data validation process for MDS based measures would be implemented to ensure accurate quality data beginning with the FY 2027 program year/FY 2025 performance period.
SNFs that submitted at least one MDS assessment record in the previous calendar year and have submitted at least one MDS assessment record in the current fiscal year are eligible for selection. Healthcare Management Solutions, LLC (HMS) is the data validation process contractor. HMS has an executed Data Use Agreement (DUA) with CMS and has the authority granted by CMS to request and receive medical records. No additional DUAs or other agreements are required to transmit medical records to HMS. The data validation process is scheduled to begin mid-January 2026.
Please see the CMS SNF Data Validation Process FAQs from CMS updated December 2025.

data-validation-process-frequently-asked-questions-12.17.2025

Respiratory Virus Outbreak Toolkit Upate

The Pennsylvania Department of Health has revised the Respiratory Virus Outbreak Toolkit. This was revised on November 24, 2025, from the 2024 version. This is information that is valuable for long term care infection preventionists to have and to use to determine managing respiratory virus outbreaks. This is also valuable information to share with medical directors, administrators, QAPI team members and when developing or revising policies and procedures related to respiratory virus outbreaks in the long-term care facilities.              Respiratory Virus Outbreak Toolkit updated 112425

Quality Measures User’s Manual (v17.0) issued by the Centers for Medicare and Medicaid Services (CMS)

The Centers for Medicare and Medicaid Services (CMS) issued version 17.0 of the MDS 3.0 Quality Measures User’s Manual which was effective January 1, 2025. The manual was issued to provide guidance regarding changes to measures that were updated by CMS.

NOTABLE CHANGES TO THE MDS QUALITY MEASURES (QM) USER’S MANUAL V17 Guidance on Selecting MDS Section GG Item Columns for Measure Calculation Guidance on the selection of MDS Section GG item columns (e.g., admission, discharge, OBRA/interim) has been revised to clarify that Section GG item values are determined by the target and/or prior assessment’s qualifying reason for assessment (RFA)1. Additional guidance on which GG item column to select when the target and/or prior assessment has more than one qualifying RFA, is also provided. The updated guidance will not have a significant impact on measure calculations.

Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (CMS ID: S038.02) (CMS Measures Inventory Tool [CMIT] Measure ID: 121)8 This quality measure is calculated using the SNF Quality Reporting Program measure Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (CMS ID: S038.02). To review the measure logic specifications for CMS ID: S038.02, please refer to the SNF Quality Reporting Program Measure Calculations and Reporting User’s Manual V6.0 on the SNF QRP website9 under the Downloads section at the bottom of the page. The measure logical specifications can be found in Chapter 8, Table 8-3.

The revised manual can be found at: MDS 3.0 Quality Measures User’s Manual v17.0

Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026

The Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (DHS) issued the final rule for FY 2026 for the PPS and consolidated billing for skilled nursing facilities. This final rule finalizes changes and updates to the policies and payment rates used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for fiscal year 2026. This final rule also updates the requirements for the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program. It was finalized on August 4, 2025 and can be found at: Federal Register :: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026

Pennsylvania Medicaid Case Mix Index Reimbursement system Transitions to PDPM

Pennsylvania is transitioning to the Patient Driven Payment Model (PDPM) for the setting of the Medical Assistance (MA) payment rates for nursing homes. This regulation was approved on June 26, 2025 and was published in the Pennsylvania Bulletin on August 2, 2025.

This change results in nursing facilities no longer being required to complete the OSA (Optional State Assessment). The PDPM replaces the RUG III that has previously been used. The transition is in process and Pennsylvania will utilize the nursing component only of the PDPM. Nursing documentation and Activities of Daily Living (ADLs) are important support components for the MDS coding for the PDPM for Medicaid Case Mix Index (CMI). Additional information can be found in the RAI Spotlight from August 2025.

RAI Spotlight August 2025