The Centers for Medicare & Medicaid Services (CMS) has released the MDS 3.0 Quality Measures (QM) User’s Manual Version 18.0, which is effective January 1, 2026. The materials were posted by CMS on December 1 and are available along with the associated files. The complete set of documents is available as a consolidated .zip file titled MDS 3.0 QM User’s Manual v18.0 Effective 1-1-2026 and Associated User Manual Files.zip, which contains six files.
The updated materials include:
- MDS 3.0 QM User’s Manual V18.0, which provides detailed specifications for the MDS 3.0 quality measures and a Notable Changes section summarizing updates from version 17.0. Key changes include the Long Stay Antipsychotic Measure and a modification to the function measure risk adjustor after the removal of item O0400 from MDS version 1.20.1;
- A Risk Adjustment Appendix File for the MDS 3.0 QM Manual, which contains the logistic regression values used to calculate risk-adjusted measures for the Nursing Home Quality Initiative, effective January 1, 2026;
- Nursing Home Compare Claims-based Quality Measure Technical Specifications, which outline technical specifications for all Nursing Home Claims-based Quality Measures;
- Nursing Home Compare Quality Measures Technical Specifications Appendix, which includes tables and appendices related to the claims-based measures;
- SNF QM User’s Manual V7.0, effective October 1, 2025, which contains detailed specifications for SNF MDS 3.0 measures, including changes from the removal of item O0400;
- A Risk Adjustment Appendix File for the SNF Quality Measures User’s Manual v7.0, which provides updated coefficient values used to calculate risk-adjusted SNF measures, reflecting the October 1, 2025 updates.
The updated .zip file containing all documents is available for download in the Downloads section of the CMS webpage here.
Compliance Perspective
Issue
CMS has released the MDS 3.0 Quality Measures User’s Manual v18.0 and associated technical files, effective January 1, 2026. These updates include revised measure specifications, notable changes to key items such as the Long Stay Antipsychotic Measure, and updated risk adjustment values for both MDS-based and claims-based quality measures. As facilities prepare for the changes that will take effect in 2026, it is important to evaluate current quality measure processes, ensure staff understanding of revised requirements, and establish internal auditing strategies to maintain compliance and accuracy in publicly reported data.
Discussion Points
- Facilities should review and update their quality monitoring, reporting, and documentation procedures to align with the revised measure specifications and risk adjustment updates included in the v18.0 manual. This may involve reviewing workflows for data entry, verification, and correction to ensure compliance with the updated guidance. Facilities that already collaborate with outside consultants for compliance support or mock survey preparation may consider requesting an updated review focused specifically on the revised MDS 3.0 QM requirements, especially for measures affected by changes to risk adjustment or item removals.
- Appropriate staff should receive training on the updated quality measure specifications, including calculation methodologies, risk adjustment changes, and how documentation affects measure outcomes. Med-Net Academy courses such as Understanding and Using the Medicare Triple Check Process and Understanding the 5-Star Rating Program may help reinforce understanding of how quality measures, billing accuracy, clinical documentation, and performance data intersect.
- Facilities should conduct audits to evaluate data accuracy, documentation quality, and potential issues that may affect risk-adjusted outcomes. Audits can uncover problems early, before they impact publicly reported data. Some organizations choose to involve external support to obtain an objective review or to conduct focused mock audits in areas identified through their QAPI process. This can help provide added insight into documentation gaps or operational trends that could affect upcoming reporting cycles.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*