Quality measures (QM) that are driven by MDS data are currently utilized for long term care (LTC) facilities and skilled nursing facilities (SNF) in several ways. These QMs are publicly reported via the Care Compare (CC) website and accompanying Five Star Ratings. MDS-driven QMs also play a significant role in the Annual Payment Update (APU) for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) – and will be playing a larger role in the Skilled Nursing Facility Value Based Purchasing Program (SNF VBP). Within a LTC or SNF, QMs are a valuable means of internal evaluation of facility policies and processes, care delivery, care planning, and preparation for health inspections or surveys.
2026 Quality Measure Changes
Three significant changes to Quality Measures begin in 2026:
- Update to the Antipsychotic Long Stay measure calculation and reporting
In January 2026, CMS plans to implement changes to the way the Long Stay measure for antipsychotic use is reported on Care Compare. Currently the long stay and short stay antipsychotic QM data is collected on the MDS, and the facility percentage is adjusted by reported exclusions – specifically diagnoses of Schizophrenia, Tourette’s syndrome, and Huntington’s disease. However, a change to this calculation was recommended after a 2021 report by the Office of Inspector General (OIG) suggested the number of long-stay residents who are receiving antipsychotic medications (reported on the MDS) may not accurately reflect the number of residents who are prescribed antipsychotic medications.
With the updated methodology calculation, CMS will include Medicare and Medicaid claims data and Medicare Advantage encounter data to supplement MDS data. Claims and Medicare Advantage encounter data will capture antipsychotic medication use that may be underreported on the MDS, and will also serve to validate the exclusion diagnoses that are reported on the MDS. In the memo QSO-25-20-NH REVISED 6/18/2025 (page 3), CMS notes the changed methodology calculation “will accurately capture antipsychotic prescribing that falls within the nursing home stay, but not within the 7-day MDS look-back window.” CMS anticipates an increase in the QM for national percentage of residents receiving an antipsychotic – from the current 14.64% to an expected 16.98% – due to the new measure’s inclusion of additional data.
This re-specified measure will begin public reporting on Care Compare in January 2026 and will use 07/01/2025 – 09/30/2025 (Q3 2025) as the initial data collection period. The MDS 3.0 Quality Measures User’s Manual v18.0 Effective January 1, 2026 has been published, with specifications on this QM located in Table 2-31.
- Update to the Discharge Function Score measure
CMS has also changed the risk adjuster “no physical or occupational therapy” with its January 1, 2026 QM updates. This measure will now use MDS discharge items O0425B and O0425C (due to the retired O0400B and O0400C) for the overall risk-adjustment model and for the statistical imputation procedure.
- Update to the Falls with Major Injury Long Stay measure calculations
Although CMS has not released any information about the timing of changes to the way the QM for falls with major injury (FMI) is calculated, it is anticipated to be published in the near future. Currently, the measure is calculated based solely on MDS data and reported not only as a QM on Care Compare but also as a SNF QRP measure and SNF VBP measure for FY 2027.
CMS has proposed to integrate the MDS-based FMI data with any claims that person may have had during the stay, in the hospital, in the ED, or during an observation stay. This will be used to assess an injury via diagnosis codes and a fall via external cause of injury codes. Claims-based information will include data from Medicare Fee-for-Service (FFS) claims, Medicare Advantage encounters, and Medicaid Transformed Medicaid Statistical Information System (T-MSIS) data from the inpatient and outpatient settings. The measure will not be risk-adjusted or stratified. This respecified FMI will be considered a “hybrid” measure. Facilities can anticipate that CMS may apply the same approaches to improve other types of MDS reporting from which nursing home quality measures are derived in the future.
Steps to Prepare
In preparation of these upcoming QM changes:
- Review the January 2026 updates on the methodology for calculating the QM for antipsychotic use.
- Anticipate that individual facility antipsychotic QM rates may increase, and the change will be reflected in the Care Compare website reporting.
- Ensure staff are trained to collect data correctly, and data collection tools in use are up to date/reflect the MDS data that is required.
- Verify that every resident with the diagnosis of schizophrenia has sufficient and accurate supporting documentation in the record.
- Confirm that every resident who is receiving an antipsychotic has documentation that supports the use (provider notes, dx, care plan, etc).
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