The 2026 MDS 3.0 Updates Are Coming. Here’s What SNFs Need to Know — and How to Protect Performance.

CMS has released the MDS 3.0 Quality Measures User’s Manual v18.0, which goes into effect January 1, 2026. The update brings changes to some of the most important measures that influence quality ratings, staffing reputation, reimbursement, survey exposure, and relationships with hospitals and ACOs.

If the changes feel constant, it’s because they are. And for operators, the challenge isn’t understanding CMS’s intent — it’s keeping documentation accurate and consistent across staff, shifts, buildings, and turnover.

This update makes that even harder. But there’s also an opportunity: SNFs that stay ahead of documentation accuracy requirements improve both quality performance and financial stability.

Let's break down what’s changing and what it means for your facilities.

What’s Changing in 2026 (and Why It Matters)

1. The Long-Stay Antipsychotic Measure Gets Stricter

CMS tightened the rules around diagnoses and exclusions for residents receiving antipsychotics.

What this means for operators:

• Incorrect or incomplete diagnoses may no longer count as exclusions
• Your long-stay quality rating could move significantly
• Survey focus on psychotropic documentation will increase
  
  

Facilities already working to reduce psychotropic use will still need tighter documentation to avoid measure inflation.

2. Functional Status Measures Now Fully Depend on Section GG

With Section G removed from the MDS, CMS recalculated risk adjustment for mobility and self-care measures.

Operator impact:

• Inconsistent Section GG coding will now hurt performance
• Rehab-driven documentation variation (weekdays vs. weekends) becomes more costly
• High-functioning facilities may see shifted expected rates

This is an area where small inconsistencies create big swings.

3. Pressure Injuries, Falls, and Vaccinations Are Seeing Definition Updates

These aren't full rewrites — but they’re changes that create risk if teams don’t code consistently.

In practice:

• Falls must be documented more precisely to avoid over-reporting
• Pressure injury staging must be consistent across assessments
• Vaccination refusal documentation must be complete and appropriately justified

These are measures that surveyors and care partners already monitor closely.

4. Financial Programs Will Feel the Impact

These QM changes feed directly into:

• QRP penalties
• VBP incentive opportunities
• Public Care Compare ratings
• Hospital referral steering decisions

Better documentation = better numbers = stronger market position.

The Real Challenge: Your Teams Don’t Have Cycles for Another Training Wave

Every time CMS updates the MDS or QM rules, operators feel the same pain points:

• Documentation retraining across all buildings
• Inconsistency across RNs, MDS coordinators, and floor staff
• Staff interpreting rules differently
• New hires receiving outdated guidance
• Performance slipping because documentation can’t keep pace
  
  

The issue isn’t effort — your teams work hard. The issue is burden: MDS complexity grows every year, but staffing capacity does not.

Traditional plans like “tighten documentation” or “retrain the teams” can’t scale across multi-facility operations anymore.

How Cascala Helps SNFs Stay Aligned Without More Burden

As regulations evolve, Cascala gives SNFs a way to maintain accuracy and performance without relying on manual retraining or adding “one more thing” to staff workflows.

Cascala supports operators by:

• Embedding CMS-aligned guidance directly into documentation workflows;
  Staff get clarity at the point of need — not after-the-fact audits.
• Creating consistency across teams and shifts;
  Reduces variation between seasoned and new staff.
• Helping prevent common MDS errors before they impact measures;
  Reduces miscoding, missing items, and incorrect exclusions.
• Lowering cognitive load during documentation;
  Teams don’t have to memorize hundreds of rule changes.
• Improving quality-measure performance across facilities;
  Operators gain confidence that documentation is accurate system-wide.
  
  

Cascala adapts when CMS updates definitions or risk-adjustments so your facilities stay aligned without months of catch-up work.

What Operators Should Do Now to Prepare for 2026

• Review where variation exists in Section GG, falls, pressure injuries, and psychotropic documentation
• Audit measure performance to see where denominator or exclusion shifts may impact ratings
• Identify buildings with inconsistent documentation across weekdays, nights, or staffing patterns
• Adopt tools that reduce documentation inconsistency at the source

CMS will always issue annual updates. SNFs don’t need more manual work — they need systems that make documentation more reliable.

The Bottom Line

The 2026 QM changes are another reminder that SNF performance is increasingly tied to documentation accuracy, not just care delivery.

Facilities with consistent and precise documentation will:

• Perform better on quality measures
• Reduce financial penalties
• Strengthen relationships with hospitals and ACOs
• Improve survey outcomes
• Increase competitiveness in their market
  
  

Cascala gives SNF operators a sustainable way to keep up — and stay ahead — without increasing burden on staff. Give your teams clarity instead of complexity.

Connect with Cascala to see how AI-driven workflow support reduces burden and improves documentation consistency.

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