Plain guides for MDS and quality teams.
How the measures, the stars and the state programs actually work, written for the people who code the MDS and answer for the scores.
Long-stay measures from the MDS
Residents in the building more than 100 days. All in Five-Star.
The long-stay ADL decline quality measure (N028)
How CMS compares four Section GG items across two assessments, why a refusal code counts as dependent, when a decline clears, and the Five-Star points.
Ability to walk independently worsened: the N035 measure
GG0170I compared with the prior assessment: what counts as a decline, who is excluded (including the first assessment after a hospital return), risk adjustment and Five-Star points.
The long-stay pressure ulcer quality measure (N045)
Which M0300 items put a resident in the measure, why present-on-admission doesn’t matter, when a healing ulcer clears, and what the October 2026 RAI Manual changed.
The long-stay catheter quality measure (N026)
H0100A’s 7-day look-back, what counts as an indwelling catheter, the neurogenic bladder and obstructive uropathy exclusions, and the narrow Five-Star bands.
Falls with major injury (N013): what counts, and for how long
The 275-day look-back scan, why one J1900C counts for about a year, the current major-injury definition, and what changed in RAI v1.20.11.
The long-stay UTI quality measure (N024): the 30-day look-back
How I2300 is coded, why the 30-day window and the target assessment decide whether a UTI counts in your quarter, and how Five-Star scores it.
The long-stay antipsychotic measure: N047.01 and claims data
Since January 2026, Five-Star’s antipsychotic measure reads Medicare and Medicaid claims too. What counts, who is excluded, and why stopping a drug clears a quarter later.
Long-stay measures from claims
Built from Medicare claims, not the MDS. All in Five-Star.
Short-stay measures from the MDS
SNF stays of 100 days or less. All in Five-Star.
The discharge function score quality measure (S042.03)
How CMS scores a short stay against its expected discharge function: the 10 GG items, how “activity not attempted” codes are imputed, and which stays are excluded.
New or worsened pressure ulcers, short stay (S038.02)
The PPS Discharge decides this measure. How M0300 “present on admission” works, the unstageable rules, the October 2026 reopened-ulcer change, and how Five-Star scores it.
Antipsychotic for the first time, short stay (N011.03)
How the initial and target assessments work, why prochlorperazine counts, which residents are excluded, and how one resident moves the Five-Star points.
Short-stay measures from claims
Hospital returns, ED visits and discharges home. All in Five-Star.
Short-stay rehospitalization and ED visit measures, explained
Two Five-Star claims measures that count hospital and ED trips within 30 days of entry, even after discharge. Who’s in, the lag, and where the 5-Day feeds the risk model.
Successful return to home and community from a SNF
The two-year claims measure of residents discharged home who stay alive and out of the hospital for 31 days: discharge status codes, exclusions and scoring.
Measures outside Five-Star
On Care Compare, and used by state quality programs.
The depressive symptoms quality measure (N030.03), explained
How the PHQ-2 to 9 and PHQ-9-OV put a long-stay resident in CMS’s depressive symptoms measure, who is excluded, the new closest-to-ARD rule, and common coding mistakes.
The antianxiety or hypnotic medication quality measure (N036.03)
N0415B1 and D1 in the 7-day look-back decide it. How N036 differs from the surveyor-only N033, who is excluded, and why you code the drug class, not the use.
The long-stay weight loss quality measure: coding K0300 (N029.03)
K0300 = 2 puts a resident in the measure; code 1 needs a documented weight-loss goal. The 30- and 180-day math, the exclusions, and common coding mistakes.
New or worsened bowel or bladder incontinence (N046.02)
The low-risk bowel and bladder measure was retired in 2023. How its replacement compares H0300 and H0400 across two assessments, who is excluded, and how it’s risk-adjusted.
The physical restraints quality measure: what P0100 counts
Only five P0100 items, coded as used daily, count toward N027.02. Which ones, how to judge a device by its effect, and the October 2026 locked-unit line.
Prevalence of falls (N032.02): the survey measure behind J1800
Any fall coded at J1800 counts, with or without injury, and stays for about a year. How the surveyor-only falls measure works and what counts as a fall.
Behavior symptoms affecting others (N034.02): the survey measure
Behaviors, rejection of care and wandering in the 7-day look-back put a resident in this iQIES-only measure. What counts, what doesn’t, and when a refusal isn’t coded.
The long-stay flu and pneumococcal vaccine quality measures
Given, declined or not eligible all count as success on N016.03 and N020.02. How the flu season window works, what up to date means, and which codes count as a miss.
Rule changes
What CMS changed in the RAI Manual, the QM manual and Five-Star.
October 1, 2026: RAI Manual v1.20.11 and FY2027 MDS changes
No new item set, but a reversed present-on-admission rule, interview-timing rules, O0350 made voluntary, and shorter QRP deadlines starting in 2027.
Five-Star July 2026: the QM rating thresholds went up
CMS raised every QM star threshold in July 2026, the first move since January 2025. Old vs new cut points, what it means, and the other 2025–26 changes including the trophy icon.
QM User’s Manual v18.0: what changed, and the new antipsychotic QM
v18.0 (Jan 2026) re-specified the long-stay antipsychotic measure (N047.01) with claims and encounter data, and changed its exclusions. Also the DFS adjuster change and the March 2026 errata.
RAI Manual v1.20.1 (October 2025): what changed on the MDS
The October 2025 MDS: A0810 Sex, A1255, new O0390, a wider fall and major-injury definition, clearer weight rules, and new N0415 and GDR coding tips.
Guides
State programs, trackers and the work around the measures.
How the Ohio QIP floor works, and what crossing it costs
Ohio zeroes every metric point below its SFY2027 floor of 35.75. Here is how the floor is set, why a quarter of buildings land under it, and what one resident can cost.
Why your QM tracker spreadsheet is always out of date
The spreadsheet isn’t the problem. The data it’s built from is two quarters old before anyone types it in. What that lag costs, and what a live tracker does differently.
See where your building stands.
Your stars, your measures and your state program. Free, from public data.
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