CMS MDS QM Manual v18.0: Key Changes Operators Must Know
CMS has released the MDS 3.0 Quality Measures User’s Manual v18.0, effective January 1, 2026. The update is not a wholesale rewrite, but it introduces a few important changes that MDS and clinical leaders should understand.
In this post, we’ll briefly walk through what changed from v17.0 to v18.0, why the long-stay antipsychotic measure will feel different, and how MedaSync helps you maintain real-time visibility, so you are not surprised when public quality data refreshes.
What Changed in the MDS QM User’s Manual v18.0
According to CMS, v18.0 keeps the overall QM framework intact and narrows the actual updates to a small set of items:
1. Long-stay antipsychotic measure re-specified and renumbered:
- In v17.0, the long-stay measure “Percent of Residents Who Received an Antipsychotic Medication” used CMS ID N031.04 and relied only on MDS 3.0 data.
- In v18.0, a re-specified version (N047.01) now incorporates Medicare and Medicaid claims and encounter data in addition to the MDS, with first public reporting scheduled for January 2026.
- The revised specifications appear in Table 2-31 of the new manual.
2. Discharge Function Score risk adjustment updated for therapy item changes
- Therapy minute items O0400B/C were retired in MDS v1.19.1.
- New item O0425B/C now serves as the source for the “no PT/OT therapy” risk adjuster in the Discharge Function Score measure (S042.03).
3. Technical update for the long-stay walking measure
- CMS updated the data element name and item number for A0810 (Sex), used in risk adjustment for measure N035.06.
CMS notes that the transition does not affect any other NHQI quality measures, so remaining v17.0 logic carries forward.
What’s different about the long-stay antipsychotic measure:
Previously, the long-stay antipsychotic measure depended entirely on what was recorded on a single MDS assessment. Beginning with v18.0’s re-specification, CMS will also use Medicare and Medicaid claims to identify antipsychotic exposure. This broader view can surface medication use not captured in MDS coding alone, which means your reported antipsychotic rate may shift even if internal prescribing patterns remain stable.
How MedaSync helps you stay on top of quality measures
MedaSync is already helping hundreds of post-acute operators streamline how clinical, medication, and documentation data come together. By bringing information from multiple systems into one place, MedaSync gives teams the clarity they need to stay ahead of quality-measure impact.
- Real-time visibility across systems
MedaSync consolidates medication, clinical, and MDS data so teams can quickly see antipsychotic use, functional changes, and other quality-relevant indicators at the resident, unit, and facility levels. - Stronger alignment between documentation and coding
The platform highlights where diagnoses, assessments, and care plans are not telling the same story, helping teams correct discrepancies before they influence quality outcomes. - Clear insight into key clinical drivers
MedaSync surfaces the MDS items and clinical factors tied to quality measures, giving operators a consistent view of how resident care patterns may influence their overall quality profile.
Where to go next
Download the MDS 3.0 Quality Measures User’s Manual v18.0 from the CMS Nursing Home Quality Initiative website and share it with your MDS and clinical leadership teams. Reviewing it alongside your current workflows is the best way to confirm that your internal monitoring aligns with CMS’ updated logic.
If you would like to see how MedaSync surfaces antipsychotic utilization and other quality drivers in real time, we are happy to walk you through how operators are using AI-driven reimbursement intelligence to improve accuracy, compliance and revenue integrity.
