CMS Updates Facility and Resident Level Quality Measure Reports with New “MDS Hybrid Measure”

On December 1, 2025, the Centers for Medicare and Medicaid Services (CMS) released an updated version of the Minimum Data Set (MDS) 3.0 Quality Measure (QM) User Manual v18.0. This update, effective January 1, 2026, includes updated guidance and a detailed new specification for the long-stay Antipsychotic Medication Use QM. The updated manual can be downloaded from the CMS Quality Measures website.

A key change in this manual is the introduction of a new “MDS Hybrid Measure” for the long-stay antipsychotic medication use QM. As of January 2026, newly generated MDS 3.0 Facility-Level and Resident Level QM reports include a new section titled MDS Hybrid Measures where the updated measure information can be found on both Facility and Resident-Level reports. See example updated report below:

What is the MDS Hybrid Measure for Long Stay Antipsychotic Medication Use

Under the updated specification, the long-stay antipsychotic medication use QM can trigger in the following ways:

1. MDS-based Numerator Trigger

• An MDS assessment with target date coding N0415A1, indicating antipsychotic medication was administered in the 7 day look-back period

OR

2. Claims-based Numerator Trigger

• A claim or encounter record for antipsychotic medication during the target period while the resident was in the facility. This includes:

  • Pharmacy claim (Medicaid or Medicare Part D) for an antipsychotic medication during the nursing home stay based on fill date

  • Physician visit or outpatient claim (Medicaid or Medicare) for physician administered antipsychotic medication

This hybrid approach brings together clinical MDS assessment data with administrative claims information to identify antipsychotic medication use more comprehensively.

New Exclusions with the Hybrid Measure

With this hybrid measure structure there are several new or clarified exclusions from the antipsychotic medication use quality measure:

• Residents not continuously enrolled in Medicare and/or Medicaid plans for the relevant period

• Diagnosis based exclusions for schizophrenia, Tourette’s syndrome or Huntington’s Disease. CMS clarified that for these diagnoses to qualify for exclusion they must be reported on the MDS Section I and also documented on the claim billed

• Residents receiving Medicare Part A or Medicaid covered hospice services or enrolled in hospice based on claims billing data

  
  

These updated triggers and exclusions reflect CMS efforts to more accurately capture appropriate antipsychotic medication use among long stay residents while also accounting for clinical complexity and payer coverage.

What This Means for Post Acute Providers

Post acute leaders should be aware that MDS 3.0 QM reporting now incorporates claims data for this quality measure. The addition of the MDS Hybrid Measure represents a significant change in specification that may affect quality performance results beginning with reporting in January 2026.

Questions? The Engage Consulting team is here as a resource.