What long-term care dietitians need to know: Updated 2023 MDS documentation

Updated MDS documentation has come to long-term care facilities beginning on October 1, 2023. The motivation behind the change is to better align documentation with goals for the Centers for Medicare and Medicaid Services’ Patient-Driven Payment Model reimbursement structure, introduced in 2019.

Changes to section K

The updated MDS features minimal changes for Section K, the portion of the document that addresses nutritional status. Section K0510, Nutritional Approaches, has been updated and is now labeled Section K0520.

In the new K0520 box, CMS has added two additional time frames to assess the resident’s feeding method. Dietitians or MDS coordinators will now identify the resident’s feeding method (i.e., parenteral/IV feeding, feeding tube, mechanically altered diet, etc.) at the time of admission, while not a resident, while a resident, and at discharge. CMS added “at the time of admission” and “at discharge” to this section.

• “At the time of admission” refers to days 1 through 3 at the skilled nursing facility.
• “While not a resident” refers to the previous 7 days before the resident was admitted to the skilled nursing facility.
• “While a resident” refers to the previous 7 days prior to date of MDS completion while a resident was admitted to the skilled nursing facility.
• “At discharge” refers to the last 3 days of the resident’s admission to the skilled nursing facility.

Shorter lookback periods

With the updated MDS assessment, some lookback periods are shortened to 3 days. This means all MDS documentation for admissions and discharges will need to be completed within 3 days. (A portion of Section K now has a 3-day lookback period.)

It is important for skilled nursing facilities to work with hospitals and other healthcare organizations that admit patients to skilled nursing facilities to send accurate and updated documentation to jumpstart the MDS process.

This shorter timeframe may create some challenges, especially for skilled nursing facilities that do not have a full-time dietitian on staff. Skilled nursing facilities may need to consider increasing a consultant dietitian’s hours or enlisting help from a Certified Dietary Manager or Dietetic Technician, Registered to fill in the gaps and help with timely nutrition assessments. Admission coordinators can also request documentation from the acute care dietitian to help complete the updated Section K.

Other noteworthy changes

Apart from the change to Section K, there are a few other changes that may impact dietitians.

• Section B, Hearing, Speech, and Vision, now has a question on health literacy.
• Section G, Functional Status, has been removed and replaced with Section GG, Functional Abilities and Goals. Section GG focuses more on the resident’s typical abilities and what assistance they need.
• Section L, Oral/Dental Status, has been expanded and now has more options to describe a patient’s oral health and dentition.

What dietitians should do

If you are a dietitian working in a skilled nursing facility, keep in touch with your MDS Coordinator as these changes roll out. Ask questions when you need to and continue to be adaptable and patient as everyone adjusts to the updated MDS documentation.

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References:

MDS 2023: The Countdown. MDS Consultants website. https://www.mds-consultants.com/countdown-2023-mds-changes/. Accessed September 29, 2023.

Minimum Data Set (MDS) 3.0 Technical Information. CMS.gov website. https://www.cms.gov/medicare/quality/nursing-home-improvement/minimum-data-set-technical-information. Accessed September 29, 2023.