July 2 2026 | CMS Releases Fact Sheet on OBRA Discharge MDS Assessments
In case you missed it, CMS released a new fact sheet to help skilled nursing facilities (SNF) determine when an OBRA Discharge assessment is required. The fact sheet is intended to be a quick reference for MDS teams and reinforces existing guidance in the MDS 3.0 RAI User’s Manual. It is important to note that the fact sheet is intended as a supplemental resource and does not replace the detailed guidance in the User’s Manual.
The RAI manual requirements outline that an OBRA Discharge Assessment is only required when the resident meets one of the following criteria:
- Is discharged from the facility to a private residence (as opposed to going on a Leave of Absence).
- Is admitted to a hospital or other care setting (e.g., Assisted Living Facility), regardless of whether the SNF closes the record.
- Has a hospital observation stay lasting more than 24 hours, regardless of whether the hospital admits the resident.
- Is transferred to a non-certified bed
CMS has clarified that an emergency department (ED) visit by itself does not automatically require an OBRA Discharge assessment, regardless of duration. If a resident is treated in the ED and returns to the facility without being admitted to the hospital or is placed in observation status for more than 24 hours, an OBRA Discharge assessment is not required.
For example, a resident is transferred to the ED on July 1st at 9:00pm, s/he remained in the ED for an extended time due to testing and returns to the facility at 6:00am on July 3rd. In this case an OBRA Discharge MDS is NOT required. The duration of time the resident is in the ED does not impact OBRA Discharge requirements.
In another example, a resident is transferred to the ED on July 1st at 9:00pm and then placed under observation status at the hospital at 10:00am on July 2nd. The resident is then discharged back to the facility at 9:00am on July 3rd. In this case, an OBRA Discharge MDS is also NOT required since the resident was not placed in observation status for greater than 24 hours.
In a third example, a resident is transferred to the ED on July 1st at 9:00pm and then transferred to an observation bed at 10:00am on July 2nd. The resident is then discharged back to the facility at 9:00am on July 4th. In this case an OBRA Discharge MDS is required because the resident was placed in observation status for greater than 24 hours.
For skilled nursing facilities to accurately and effectively implement the OBRA Discharge Assessment criteria, action should be taken immediately to evaluate your processes to ensure compliance and understanding of the requirements. Steps should include:
- Reviewing the Fact Sheet and clarifications with your MDS teams.
- Facilities should review each transfer individually as each fact pattern may be different and follow MDS 3.0 RAI User’s Manual guidance when determining whether an OBRA Discharge assessment is required.
- Communication with external providers (hospitals, ED, Discharge Planners) will be essential to monitor for and determine the need for OBRA Discharge MDSs.
To summarize, the major change is that ED visits, regardless of duration, do not require an OBRA Discharge MDS. Before this recent CMS release, the usual practice was to complete the OBRA Discharge after 24 hours of leaving the facility, whether in the ED or observation status. So, in theory, a resident can go to the ED for days, and they would remain a resident of the facility. Keep in mind, there are separate requirements for the Part A PPS Discharge MDS.
AHCA is compiling questions to pose to CMS regarding these requirements. Some of the questions being:
How do you see facilities operationalizing this change to identify “when” observation status begins? Do you see challenges related to retroactive changes? CMS uses the OBRA Discharge MDS for quality measures – how do you see this clarification for the MDS schedule impacting quality measurement outcomes? Do you see any impact on reimbursement related to this clarification?
If you have additional questions to put forward to CMS or questions regarding these changes, emails can be sent to [email protected] or contact Elena Madrid.
