On October 1, 2025, the Centers for Medicare & Medicaid Services (CMS) rolled out updates to the Minimum Data Set (MDS) 3.0. While regulatory updates can feel daunting, they also present new opportunities: to strengthen systems, refine care practices, and ensure that every resident’s story is captured accurately and respectfully. The MDS assessment is the first step in developing that story as a key part of the overall Resident Assessment Instrument (RAI) Process.
What Changed and Why It Matters
The new MDS 3.0 (RAI User’s Manual v1.20.1) brings important updates designed to simplify reporting, align assessments with care goals, and reduce redundant data entry.
Highlights include:
- Streamlined therapy and treatment coding (new item O0390) that reduces administrative burden while keeping focus on therapy outcomes.
- Revised identification items—including changes to gender and transportation questions—to reflect current data standards.
- Updated definitions in Section J – Fall, Injury (except major). Major Injury to improve the accuracy of fall reporting.
- Elimination of Section R (Social Determinants of Health) from the final 2025 item set, postponing those items until future updates.
- Optional State Assessments (OSAs) will no longer be processed beginning October 1, 2025.
CMS indicates these updates are part of an ongoing effort to modernize assessment tools, focus on functional outcomes, and integrate care data across settings.
Looking Ahead
To ensure the transition to the new MDS 3.0 item sets remains smooth, it is important to conduct periodic testing of the RAI/MDS system and align workflows with quality assurance type activities, including:
- Staff training to ensure appropriate comfort levels with item codes and workflows,
- Technology readiness, and
- Early audits and peer reviews to ensure accurate and resident-centered coding.
We have created the checklist template below as a tool to help you through this change should you find it helpful. We anticipate these changes to bring progress, and we are excited to move forward together in partnership with you.
CLICK HERE TO DOWNLOAD THE COMPLETE CHECKLIST
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