News in MDS | September 2026
CMS has released the final MDS 3.0 RAI User’s Manual v1.20.11, effective October 1, 2026. One clarification in particular is worth putting in front of every MDS nurse and wound team.
Pressure ulcer present on admission: here’s the scenario
A resident is admitted to the SNF with a pressure ulcer. The ulcer subsequently heals and closes. Months later, the same area reopens at the same stage.
A common reaction may be: “It reopened during the stay, so now it is facility-acquired.”
Not necessarily.
The October 2026 RAI guidance clarifies that when a pressure ulcer/injury that was present on admission closes and later reopens in the same location and at the same stage, it can retain its present-on-admission status. The fact that it reopened later does not, by itself, automatically make it facility-acquired.
Why this matters: MDS coding decisions should follow the current RAI instructions and the resident-specific clinical record—not assumptions based only on when the wound reopened.
What MDS teams should do before October 1
- Replace older working copies of the RAI Manual with version 1.20.11.
- Review the October 2026 pressure-ulcer/injury present-on-admission clarification with MDS and wound-care staff.
- Make sure the record clearly supports the original wound location, stage, healing/closure and subsequent reopening.
- When a wound reopens, do not automatically label it facility-acquired without reviewing the current RAI guidance and the resident’s wound history.
Also changing for FY2027: PDPM
CMS has also released PDPM Grouper V2.5000 for assessments with target dates on or after October 1, 2026. The update supports FY2027 ICD-10 codes and includes changes to clinical-category mappings and NTA comorbidities. MDS and reimbursement teams should make sure they are working from current FY2027 resources when reviewing diagnoses and PDPM.
Knowing the rule is different from knowing how to apply it
This is where MDS education has to go beyond memorizing definitions. The MDS nurse has to take the resident’s clinical picture, documentation, interviews, diagnoses, treatments, assessment timing and RAI instructions and determine how they fit together.
That is exactly what we will practice at Elite MDS Academy.
Ready to learn MDS beyond the textbook?
The RAI/MDS Nurse Certificate Program is a live, intensive, interactive training experience for RNs and LPNs who want to build real confidence in the MDS role.
November 20–22, 2026 | Livonia, Michigan
Students will work through RAI/MDS instruction, PDPM concepts and SNF case scenarios designed to help connect the rules to what actually happens in a skilled nursing facility.
→ View the Michigan program and reserve your seat
Source: Centers for Medicare & Medicaid Services (CMS), MDS 3.0 RAI User’s Manual v1.20.11 and MDS 3.0 Technical Information. Elite MDS Academy provides education and training; providers remain responsible for following current CMS guidance and applicable payer requirements.