The discharge function score asks one question about every Medicare Part A stay: when the resident left skilled care, could they care for themselves and move around at least as well as CMS expected for someone who came in the way they did? It is a Five-Star short-stay measure worth up to 150 points, and it is scored one stay at a time, from Section GG.
What it measures
The measure is the SNF Quality Reporting Program’s Discharge Function Score, CMS ID S042.03. The MDS 3.0 QM User’s Manual v18.0 points to the SNF QRP manual for its logic, and the current version of that manual is V8.0, effective October 1, 2026. Five-Star counts it among the six short-stay measures, and it is one of the few where a higher rate is better.
The unit is a Medicare Part A SNF stay: a 5-Day PPS assessment matched to the PPS Discharge that ends the stay. Every stay in the 12-month window counts, so a resident with two Part A stays in the year is in the measure twice.
The observed score: ten GG items at discharge
CMS adds up ten discharge items (column 3), each scored 1 (dependent) to 6 (independent). The total runs from 10 to 60.
| Item | Activity |
|---|---|
| GG0130A3 | Eating |
| GG0130B3 | Oral hygiene |
| GG0130C3 | Toileting hygiene |
| GG0170A3 | Roll left and right |
| GG0170C3 | Lying to sitting on side of bed |
| GG0170D3 | Sit to stand |
| GG0170E3 | Chair/bed-to-chair transfer |
| GG0170F3 | Toilet transfer |
| GG0170I3 + GG0170J3 | Walk 10 feet, and walk 50 feet with 2 turns |
| or GG0170R3, counted twice | Wheel 50 feet with 2 turns |
The wheelchair line applies only when walking 10 feet was not attempted at both admission and discharge, and the resident has a real score (01 to 06) on wheeling 50 or 150 feet at either one. Everyone else is scored on the two walking items. Either way, it is ten items.
The discharge items describe the resident’s usual performance at the end of the Part A stay, not on the day therapy happened to go well. (CMS’s change tables for the October 2026 RAI Manual, v1.20.11, list no changes to Section GG.)
“This functional assessment must be completed within the last 3 calendar days of the resident’s Medicare Part A stay, which includes the day of discharge from Medicare Part A plus 2 previous calendar days prior to the day of discharge from Medicare Part A.”
Not-attempted codes are estimated, not zeroed
A discharge item coded 07 (refused), 09 (not applicable), 10 (environmental limitations) or 88 (medical condition or safety concerns), or left as a dash, skipped or missing, doesn’t score as a 1 and doesn’t drop out. CMS fills it in.
“If code is 07, 09, 10, 88, dashed (-), then use statistical imputation to estimate the item value for that item and use this code as the value.”
In plain words: CMS looks at the resident’s other GG scores and risk factors, works out how likely each score from 1 to 6 would have been had the activity been done, and uses the probability-weighted average. So an imputed item is usually a fraction, not a whole number. The same thing happens to not-attempted items on the admission assessment when CMS builds the admission score.
That means a not-attempted code neither sinks a stay nor rescues it. It swaps what the staff saw for a prediction. The right code is simply the one that describes what happened, and the RAI Manual is narrow about when that is a not-attempted code:
“Only use the “activity not attempted” codes if the activity did not occur; that is, the resident did not perform the activity and a helper did not perform that activity for the resident.”
The expected score: who the resident was on admission
The expected score is CMS’s estimate of where a resident like this one usually ends up. It is a regression: a starting value plus a weight for each risk factor, capped at 60. The risk factors come from the 5-Day assessment, with one exception noted below. They are:
- Age group.
- The admission function score, the same ten items in column 1, and its square.
- The primary medical condition category (stroke, hip and knee replacement, fractures, debility and so on), and how it combines with the admission score.
- Prior surgery (J2000).
- Prior functioning before this illness (GG0100) and prior mobility devices (GG0110).
- Stage 2, and Stage 3, 4 or unstageable, pressure ulcers or injuries.
- Cognition, communication, bladder and bowel continence.
- Falls in the six months before admission, nutritional approaches, high and low BMI, and comorbidities.
- No physical or occupational therapy minutes on the discharge assessment (the exception).
The weights are fixed for each period in CMS’s Risk-Adjustment Appendix File; a new file took effect October 1, 2026. Because the admission score is an input, a resident who arrives more dependent is expected to leave more dependent. That is why the 5-Day GG coding matters too. The admission assessment period is the first 3 days of the Part A stay, and it should reflect the resident before they benefit from treatment.
Who is counted
The rate is simple once each stay is scored: stays that met or beat their expected score, divided by all eligible stays.
“The total number of Medicare Part A SNF stays (Type 1 SNF Stays only) in the denominator, except those that meet the exclusion criteria, with an observed discharge function score that is equal to or greater than the calculated expected discharge function score.”
A stay is left out of both the top and bottom of the rate if any of these is true:
| Exclusion | How CMS finds it |
|---|---|
| Unplanned discharge, including against medical advice | A0310G = 2 on an OBRA Discharge dated the same day as, or the day after, the Part A end date (A2400C) |
| Discharged to an acute hospital, psychiatric hospital or long-term care hospital | A2105 = 04, 05 or 07, on the same kind of OBRA Discharge |
| Part A stay shorter than 3 days | A2400C minus A2400B is less than 3 |
| Died in the facility | The 5-Day is matched to a Death in Facility tracking record |
| Coma, persistent vegetative state, complete tetraplegia, locked-in syndrome, severe or anoxic brain damage, cerebral edema or compression of the brain at admission | B0100 = 1 or a listed ICD-10 code on the 5-Day |
| Younger than 18 | Entry date minus birth date, in whole years |
| Hospice | Discharged to hospice (A2105 = 09 or 10), or hospice while a resident (O0110K1b) on the 5-Day |
A worked example. Resident A comes in after a hip repair. At discharge, both walking items are coded 88. CMS imputes them, and the stay’s observed total lands just under its expected score, so it counts against the building. The therapy note from the day before discharge says she walked 50 feet with two turns, with contact guard assist. The activity happened, so 88 was the wrong code. If that was her usual performance over the last 3 days, the code is 04, supervision or touching assistance. The fix isn’t a better score. It’s the right one.
When it locks, and when corrections still count
Each stay is scored once, at the PPS Discharge. Nothing later in the resident’s record changes it. A modification to a wrong code counts only if CMS has it by the SNF QRP submission deadline for the quarter; after that, CMS treats the quarter’s data as frozen. For target dates before January 1, 2027, the deadline is 4.5 months after the quarter ends (August 15, November 15, February 15, May 15). From January 1, 2027, it is the 15th day of the second month after the quarter, moved to the next business day if that falls on a Friday, weekend or Federal holiday. That is three months sooner.
Common coding mistakes
- Coding 88 or 09 when the resident did the activity with help. If a helper did any of it, score the help.
- Recording the best or the worst performance instead of the usual one.
- Scoring admission after therapy has already helped, or scoring discharge outside the last 3 days of the Part A stay.
- Leaving dashes. They are imputed here, but the RAI Manual says CMS expects dash use to be rare.
- Skipping GG0100 and GG0110 on the 5-Day. They are risk factors, and a dash there scores the same as a resident who needed no help before this illness.
- Not accounting for two helpers. If two are needed, even if one only stands by, the code is 01.
See your building’s discharge function score rate, free.
How Five-Star scores it
Five-Star uses a full year of stays for this measure, not an average of four quarterly rates. Buildings are ranked by decile against cut points CMS set from 2023Q2 to 2024Q1 data, and each decile is worth 15 points.
| Discharge function rate | Points |
|---|---|
| 70.74% or higher | 150 |
| 64.80% to 70.73% | 135 |
| 60.35% to 64.79% | 120 |
| 56.61% to 60.34% | 105 |
| 53.01% to 56.60% | 90 |
| 49.31% to 53.00% | 75 |
| 44.98% to 49.30% | 60 |
| 39.95% to 44.97% | 45 |
| 33.09% to 39.94% | 30 |
| Below 33.09% | 15 |
The six short-stay measures add up to at most 800 points, which Five-Star scales by 1,150/800 so short-stay and long-stay count equally in the QM rating.
SuperQM scores each finished Part A stay against its expected score from your own MDS, and shows which open stays are near the line while there is still time to look at the coding.
Sources
- SNF QRP Measure Calculations and Reporting User’s Manual V8.0 (effective October 1, 2026), Table 8-8 and Section 7.6
- SNF QRP Risk-Adjustment Appendix File, effective October 1, 2026
- MDS 3.0 RAI User’s Manual v1.20.11 (October 2026), Chapter 3, Section GG
- MDS 3.0 Quality Measures User’s Manual v18.0, Table 2-11
- Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, September 2026, Table 4 and Appendix Table A3
