The MDS 3.0 Quality Measures User’s Manual v18.0, effective January 1, 2026, includes some notable changes to QM specifications and reporting expectations. In addition, MDS‑driven QMs are becoming increasingly impactful across Care Compare, Five‑Star Ratings, SNF QRP, and the expanding SNF VBP program. A strong Five Star QM strategy in 2026 will require the following…
Review of Recent Updates
This manual introduces updated definitions, logic, and calculation methods for multiple measures. Updates include revisions to areas such as:
- Risk adjustment refinements
- Measure exclusions
- Data element definitions
- New or revised coding instructions
One of the most notable changes is the introduction of the new Hybrid Antipsychotic Measure. The new hybrid measure replaces the prior Long Stay Antipsychotic measure which relied solely on MDS data for specification. This new measure incorporates:
- MDS 3.0 assessment data
- Medicare Part A & B claims
- Medicaid claims
- Medicare Advantage Encounter Data
- Pharmacy claims
With this hybrid measure, antipsychotic medication use is identified by using Medicare and Medicaid claims and encounter data and MDS data. Exclusions based on diagnoses also include both MDS and claims data to support the diagnoses of schizophrenia, Tourette’s syndrome or Huntington’s disease. Other exclusions for this measure include the exclusion for hospice services, and enrollment status for Medicare, Medicaid or Medicare Advantage which are derived from claims data,
These revisions are in line with CMS’s continued focus on reducing unnecessary antipsychotic medication and improving the accuracy of reporting data used to calculate the quality measures.
Effective Strategies
Effective strategies to manage the shift to a hybrid QM calculation and drive strong outcomes include:
- Educate the Interdisciplinary Team (IDT) on the hybrid methodology to ensure an understanding of what the measure captures and how to document effectively.
- Strengthen documentation—specifically, related to diagnoses. Confirm diagnoses coded on the MDS and claims are supported by the medical record and physician documentation. Review diagnoses at least quarterly for accuracy and ongoing appropriateness
- Implement effective nonpharmacological interventions to strengthen behavioral health programs through individualized resident centered care planning, on the use of root cause analysis, and provide ongoing education related to dementia management, including de-escalation techniques
- Expand focused audits related to antipsychotic use to include a review of all residents with antipsychotic medication orders and any newly started on these medications and validate documentation supporting a clinical rationale justifying the ongoing need. Consider Gradual Dose Reduction (GDR) and deprescribing when appropriate.
- Improve Drug Reconciliation practices on admission. Review hospital transfer paperwork and discharge summaries for antipsychotic orders, clarify the clinical rationale for use with the provider, and assess the need to continue antipsychotic medications at the time of admission.
- Monitor your facility level and resident level hybrid reports to track and trend the data over time, understand how claims data affects your QM score, identify residents included in the measure and target specific residents for review.
- Integrate hybrid QM management systems into your QAPI program.
A strong, focused SNF Five‑Star Quality Measure (QM) strategy in 2026 requires mastering the new MDS 3.0 v18.0 updates, anticipating CMS’s expanded use of quality data, and building a continuous‑improvement framework. The new hybrid antipsychotic QM is a major shift in how data is used to evaluate SNF performance. Facilities must proactively strengthen documentation, improve resident centered behavioral management strategies and utilize a QAPI driven approach to maintain strong quality outcomes and Five Star ratings.
Next Steps:
- Schedule an antipsychotic medication review with Proactive Clinical Nurse Consultants
- Contact us for IDT behavioral health training and program development
- Make plans to join Proactive beginning in February for the 6 week webinar series Roadmap to 5-Star Wins
Written By:
Christine Twombly, RN-BC, RAC-MT, RAC-MTA, HCRM, CHC
Senior Consultant
Was this article helpful? Access weekly insights when you sign up for our weekly newsletter!