This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023

What You Can Expect to See

The reconciled medication list will have a new documentation requirement that will go into effect with the October 1, 2023 changes to the MDS 3.0.  This new requirement will have an impact on a facility’s Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and Quality Measure (QM) item.

What Is Changing

This measure will assess the transfer of the reconciled medication list from the SNF to the subsequent provider, with the goal to both ensure continuity of care and minimize safety risks to the patient/resident.

Two data elements will be used in the calculation. The single standardized patient data element (SPADE) will ask the question, “At the time of discharge, did the facility provide the patient’s/resident’s current reconciled medication list to the subsequent provider?”  The second data element will ask the route of transmission the facility used to transfer the reconciled medication list.

The denominator of this measure will be the number of covered SNF Medicare A residents that have a stay that ends in a discharge. This item will be coded in the updated MDS 3.0 in section A.

The numerator will be the number of stays that the MDS 3.0 coded item A2121 and item A2123.

This measure’s time window will be calculated quarterly and will include all SNF stays during the quarter. If a resident has multiple stays during a single quarter, each stay will be included in the measure.

Item(s) A2122 and A2124 will code the route(s) that the current reconciled medication list was transmitted to the subsequent provider. This item is specific to patients/residents discharged to a short-term general hospital, another SNF, hospice, inpatient psychiatric facility, etc.

Recommendations from MDS Consultants

  • Meet the minimum 80% completion threshold of assessments required for reporting quality measure
  • Standardize patient assessment data using the MDS
  • Ensure accurate and supportive documentation is present in the medical record to accurately code items A2105 and A2121-A2124 on the MDS

Starting October 1, 2023, through December 31, 2023, the SNF QRP will begin assessing and reporting on both Transfer of Health (TOH) Information to the Patient Post-Acute Care (PAC) and the TOH Information to the Provider PAC. The submission deadline for these items will be May 15, 2024.

More Resources

Explore More Posts from MDS Consultants

Reimbursement Concerns

Interim Payment Assessment (IPA) – To do or not to do?

The Patient-Driven Payment Model took effect in October of 2019. Along with this change came the optional IPA. We are now five years into this change and questions still arise on when to complete an IPA. The decision of when to complete lies with the team at the...

Resident Interviews – What are you doing to capture the data?

Effective October 1, 2023, several resident interviews were added to or updated on the MDS. Interview items in Section A and changes to the interviews in Section D, J, and Q have been implemented. Each of the interviews can be a great steppingstone in your path to...

Social Determinants of Health (SDOH) – A Global Initiative Important to Skilled Nursing Providers

The Centers for Medicare & Medicaid Services’ (CMS) Office of Mental Health report CMS Framework for Health Equity 2022 and 2032 states that health equity is defined by the attainment of the highest level of health for all people, where everyone has a fair and...

OSA or PDPM? A State-Level Decision

As of Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) has retired the A0300 Optional State Assessment (OSA) from the federally required MDS 3.0 v1.18.11 that is submitted by nursing facilities. The OSA is now a separate optional MDS assessment...

Achieving Accurate ADLs with the OSA

Section G of the MDS 3.0 was retired October 1, 2023, yet the MDS nurse may still need to use the knowledge of accurately coding ADLs with an assessment called the Optional State Assessment (OSA).  State-Optioned OSA Although the option to choose an OSA from the...

Read more on Toolbox Essentials

Focused Infection Control Surveys and Directed Plan of Correction

It's a dreary Monday morning, and the state surveyors walk into your facility to conduct a Focused Infection Control survey. You and your team have been trying your hardest to comply with infection control procedures throughout the pandemic. At the end of the survey,...

New Advanced Beneficiary Notice

Is your facility using the proper ABN form? The Centers for Medicare & Medicaid Services (CMS) recently updated the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The new ABN will be mandatory for use on 1/1/2021, but the new form can be...

Covid-19 and Skilled Status

In late June, CMS addressed two issues and posted MDS 3.0 Final Item Sets (V1.17.2).  The two edits were changes to facilitate the calculation of Patient-Driven Payment Model payment codes on OBRA assessments for states that wish to have this calculation performed. ...

Mind Your PHQs

Some skilled nursing facilities (SNFs) are concerned about accurate payment when a resident unexpectedly discharges and the Brief Interview for Mental Status (BIMS) has not yet been completed.However, they should be just as concerned about the PHQ-9. The PHQ-9...

MDS in the Emergency Preparedness Plan

The COVID-19 pandemic has highlighted the need for skilled nursing facilities to have an effective Emergency Preparedness Plan - one that includes sheltering-in-place. The Centers for Medicare and Medicaid Final Rule requires that participating providers have an...

MORE from MDS Experts

Section GG Documentation – Questions Still Abound

Section GG remains a popular discussion topic among the Nurse Assessment Coordinator (NAC) and other members of the interdisciplinary team (IDT). Many have questioned their own practices and processes, designed to support coding this section of the MDS. CMS states in...

Social Determinants of Health (SDOH) – A Global Initiative Important to Skilled Nursing Providers

The Centers for Medicare & Medicaid Services’ (CMS) Office of Mental Health report CMS Framework for Health Equity 2022 and 2032 states that health equity is defined by the attainment of the highest level of health for all people, where everyone has a fair and...

Trauma and the MDS – A Sneak Peak

Trauma informed care has become an area of focus for Post Acute Care providers and survey agencies. Organizations are required to provide trauma-informed care that meets “professional standards of practice and accounting for residents’ experiences and preferences in...

New Year….Same MDS Obstacle Course

As we ring in 2024, long term care professionals are still struggling to implement the October 2023 updates to the MDS. CMS is already talking about more changes in 2024, and the anticipation continues to create anxiety amongst PAC members. While the full...

Schizophrenia Diagnosis Audits

On January 18th, 2023, CMS announced they will be conducting off-site audits in nursing homes for assessment accuracy and coding of residents with a diagnosis of Schizophrenia. Along with auditing for appropriate diagnosis, the audits will review appropriate use of...

Webinars & Training

Grow your knowledge with our MDS education

MDS Guides & Forms

Exclusive resources & tools we use every day

Ask an Expert Forum

Members can get 1:1 advice from our MDS experts

Let's Meet in Person

Get more info on our training & conference schedule

News for MDS Experts

Browse our blog & get news alerts on MDS changes

MDS Completion

Get your MDS' done ASAP with short-term, expert help

Remote Floater

Fill gaps on your team when & where you need

Case Mix Index

Improve your complex case mix calculations

MDS System Mgt

Best practices for MDS schedules & workflow

+ More Services

Get help on PDPM, ICD-10, quality, schizoph. audits ++