New MDS 3.0 RAI Manual 2025 (v1.20.1) Released - What SNFs Need to Know
- kendran68
- Sep 2
- 3 min read
Updated: 1 day ago
The Centers for Medicare & Medicaid Services (CMS) has posted on Friday August 29, 2025, the Final MDS 3.0 Resident Assessment Instrument (RAI) User’s Manual version 1.20.1, which will take effect on October 1, 2025. This update marks a significant shift in assessment items, Quality Measures, and overall coding requirements for Skilled Nursing Facilities.
CMS has also published the final MDS 3.0 Item Sets v1.20.1v3 and their corresponding Item Matrix, also scheduled to go live on October 1, 2025.
Key Changes in the New RAI Manual & Item Sets
These updates introduce several important revisions including some key items identified below:
Section A Updates:
A0800 “Gender” has been revised to A0810 “Sex”.
Transportation: The former item A1250 has been simplified and re-coded as A1255 and is only required when a resident has been in the community for less than 366 days.
Section GG Updates:
Multiple clarifications provided in GG coding including, that some activities may be performed multiple times during an assessment period, whereas other activities may only occur once.
Section J Updates:
Multiple definitions changed including:
Fall: Now includes incidents that are the result of an overwhelming external force
Fall with Major Injury: New definition: “Includes, but is not limited to, traumatic bone fractures, joint dislocations/subluxations, internal organ injuries, amputations, spinal cord injuries, head injuries, and crush injuries”. Additionally clarifies that fractures confirmed to be pathologic are not considered a major injury.
Section O Updates:
Therapy Services: Most therapy-related items under O0400 have been consolidated into a single streamlined item: O0390 “Therapy Services”.
Section R - No longer Required – Social Determinants of Health: CMS has removed Section R, which previously included items like Living Situation (R0310), Food (R0320), Utilities (R0330), and Transportation (R0340). These changes reflect policy decisions outlined in the FY 2026 SNF PPS Final Rule.
Major Injury Categorization
1. Coding Accuracy & Compliance
The consolidation of therapy items (O0390) and removal of Section R requires updates to internal assessment workflows and coding logic.
Misapplication may lead to inaccurate MDS submissions, impacting data integrity.
2. Quality Measure Reporting
The long-stay and SNF QRP measure “Fall with Major Injury” QM is highly sensitive to how and when injuries are recorded. Updated definitions will materially affect facility performance outcomes.
Other QMs, like Discharge Function Score and emerging VBP-exclusive measures, also hinge on accurate item coding and Section GG/G change integration.
3. Financial Impact: QRP & VBP
SNF QRP: Facilities that fail to meet MDS data completion thresholds or submit inaccurate data may face penalties, up to 2 percentage points off their Annual Payment Update (APU).
SNF VBP: Incentive payments are tied to performance metrics like falls with major injury. Any fluctuation in coding or measure definitions can directly influence VBP bonus outcomes.
Next Steps: What SNF Leadership Should Do
Download & Review the final RAI Manual v1.20.1 and final Item Sets v1.20.1v3 from the CMS RAI Manual page.
Update Assessment Templates, coding guides, and staff training to reflect changes of items (A0810, A1255, O0390), and therapy consolidation.
Monitor CMS communications, especially guidance on revised fall with major injury definitions and Quality Measure updates referencing the July TEP report.
Audit MDS submissions to ensure compliance, accuracy, and readiness for SNF QRP data thresholds and VBP quality scoring.
Significant structural changes, like therapy item consolidation, and item renaming, have sweeping implications for coding accuracy, quality measure reporting, and financial programs.
In particular, the Fall with Major Injury measure, which is expected to be recalibrated and could alter Quality Measure and VBP outcomes.
To stay ahead, SNFs must rapidly adapt training, coding, and QA workflows, while closely tracking CMS for further updates and key MDS 3.0 RAI Manual 2025 changes.
For easy reference, we’ve created a PDF version of the October 1, 2025 MDS RAI Manual updates—perfect for printing or sharing. Click the button below to download.