2026 RAI Manual Updates: Where MDS Teams Should Focus
Keeping up with RAI Manual updates is part of the job for MDS professionals. Finding time to understand what those changes mean for the work already in front of them can be harder. Assessments still need to be completed, documentation still needs to be reviewed, and questions from the rest of the team do not pause while everyone gets familiar with new guidance.
The October 2026 updates offer an opportunity to take a closer look at familiar routines. The updated manual, version 1.20.11, took effect October 1, 2026. Two changes deserve particular attention: how teams code pressure ulcers that heal and reopen, and which resident interview they use when more than one is completed during the assessment look-back period.
Both have practical implications that can be easy to miss in a summary of wording changes. A process may feel familiar and still need to be adjusted. That makes these updates a useful moment for experienced staff and newer team members to review their approach together.
In Section M, the updated guidance addresses a pressure ulcer or injury that was documented as present on admission, subsequently healed, and then reopened at the same stage. That reopened ulcer or injury should no longer be coded as present on admission. Teams should not carry forward the original admission status simply because the wound reopened in the same location.
Consider a resident admitted with a Stage II pressure ulcer that heals during the stay and later a Stage II pressure ulcer reopens in the same spot. The original wound history remains important, but the reopened ulcer does not retain its present-on-admission status for MDS coding. Understanding that distinction requires a clear record of the wound’s progression, including when it healed and when it reopened.
This is a useful discussion for nursing, wound care, and MDS staff to have together. Everyone involved needs a shared understanding of how healing and reopening are documented and how that history informs the assessment. Reviewing a real example can help teams identify where an existing process or assumption needs to change.
Sections C and D also clarify how to select resident interview results. When multiple BIMS interviews are completed during the applicable look-back period, teams must use the interview conducted closest to the assessment reference date, or ARD. The same approach applies to the PHQ-2 to 9 resident mood interview.
The practical point is that timing determines which interview is used. If two interviews produce different scores, teams must use the one conducted closest to the ARD, even if the earlier result would lead to a different reimbursement outcome. Having multiple results in the record does not give the team a choice about which score to report.
That makes coordination across departments especially important. Staff completing interviews and staff coding the MDS should understand how the appropriate result is selected. Reviewing interview dates, clarifying responsibilities, and updating internal checklists can help everyone follow the same process.
The changes to ethnicity and race assessment guidance also deserve attention in daily workflows. These items may be asked on admission and reassessed annually, with prior responses used on intervening assessments. For subsequent assessments, prior race and ethnicity responses may be used when it has been less than a year since the resident was last asked. Once a year or more has passed, the resident should be asked again. Putting that into practice means establishing a reliable way to track when the resident needs to be asked again and who is responsible for that follow-through.
Other updates reinforce the connection between documentation and coding. Skilled respiratory therapy guidance distinguishes skilled services from routine maintenance, making it important for the record to support the nature of the services provided. CMS also clarifies that state or payer requirements do not replace, modify, or add to CMS coding requirements for MDS items outside Section S.
Making these updates useful does not require covering every change in one meeting. A focused review can start with the workflows most affected in your organization. Identify who needs to understand each change, review the relevant manual language, and decide whether an existing process or training resource needs adjusting. Giving staff a clear place to raise questions helps resolve uncertainty before different interpretations become routine.
That kind of support matters for newer MDS professionals, who are still learning how documentation connects to assessment decisions. It also gives experienced staff time to check assumptions and share their reasoning. Working through a change together helps build consistency across the team.
Technology can support that work by making relevant clinical information easier to review. MedaSync helps teams bring clinical and reimbursement information into view so they can focus their attention and make more informed decisions. The RAI Manual, supporting documentation, and professional judgment remain essential to applying the guidance correctly.
The value of reviewing an update comes from what happens afterward. When teams understand how the guidance applies to their responsibilities, they are better prepared to carry it into the next assessment and the decisions that follow.
Give your team a practical reference for the October updates. Download MedaSync’s summary of the 2026 RAI Manual changes for key updates and suggested actions. Share it with your MDS, nursing, therapy, and reimbursement teams to guide your next discussion.
