CMS respecified falls with Major Injury measure: Why it matters
Through its Quality Reporting Programs (QRPs), the Centers for Medicare & Medicaid (CMS) establishes and maintains quality measures designed to improve care outcomes and give Medicare beneficiaries and their families better information when choosing healthcare providers.
CMS routinely evaluates and refines QRP measures and measure sets to ensure cross-setting alignment, facilitate and implement improvements, and maintain measure effectiveness for each care setting. The Falls with Major Injury (FMI) measure is a cross-setting quality metric that tracks the percentage of patient stays or care episodes in which a fall results in a major injury.
The FMI quality measure was implemented for home health in calendar year (CY) 2019 when CMS started requiring reporting of these incidents via the OASIS instrument for purposes of the Home Health Quality Reporting Program (HHQRP), and was subsequently publicly reported on the Medicare Care Compare website in CY 2022 to track home health agency (HHA) performance.
In this blog, we explore these new updates and how they can impact your organization.
The respecified FMI measure
In CY 2023, the Office of the Inspector General (OIG) published an OIG report that noted that 55% of hospitalizations due to falls resulting in major injuries were not reported by HHAs on the corresponding OASIS assessment.
In this report, the OIG urged CMS to do a better job ensuring that HHAs are fully and accurately reporting falls with major injury in OASIS. The OIG also recommended using additional data sources beyond OASIS to improve the measure’s accuracy, making sure required OASIS assessments are submitted when patients are hospitalized, and looking at whether these improvements could strengthen other home health CMS quality measures as well.
CMS agreed with all four recommendations.
In response, CMS conducted a Technical Expert Panel (TEP) in July 2024 that resulted in the TEP proposing to broaden data used in the FMI measure calculation from only using OASIS-based data (in home health) to using both assessment-based data and claims data. CMS then held a second TEP in May 2025 that focused on the best method for the inclusion of the claims data in the measure specifications and how “major injury” should be defined for the measure calculation.
In the CY 2026 Home Health Final Rule, CMS announced plans to respecify the FMI quality measure, and of important note, also requested information on adding a respecified FMI measure to the Expanded Home Health Value-Based Purchasing (HHVBP) model measure set, which is now being considered in future rulemaking.
In January 2026, CMS then released updated technical specifications (FMI Technical Specifications Report) for the respecified FMI quality measure, expanding it into a hybrid measure that combines OASIS data with Medicare and Medicaid claims and encounter data from hospitals, emergency rooms and observation stays.
The updated technical specifications expand the definition of a major injury to include additional ICD-10-CM diagnostic categories and revise the list of ICD-10-CM external cause codes that may appear on a claim and signal that a fall occurred.
FMI OASIS items
Included in key technical changes for the respecified FMI measure is updated OASIS guidance for coding the FMI OASIS items:
- J1800 (Any Falls Since SOC/ROC)
- J1900 (Number of Falls Since SOC/ROC)
These were updated with new definitions for falls and a broadened definition of “major injury” that was expanded to be more inclusive.
In January 2026, CMS released an Home Health J1800/J1900 Errata for OASIS E1, which includes the updated definitions that expand on the definition of “falls” and “major injury” for home health OASIS data collection and includes updated coding guidance, examples, and tips.
CMS had also previously provided updated guidance for the coding of the FMI items in the October 2025 CMS Quarterly OASIS Q&As released in November 2025.
Why it matters
The respecified FMI measure for home health will be implemented for data collection purposes starting January 1, 2026. Updated guidance for OASIS coding (items J1800 and J1900) also became effective on this date.
The first public reporting on Care Compare of the measure scores, calculated using data from Q2 2026 through Q1 2027, is anticipated in October 2027. In the interim, home health agencies (HHAs) will have access to their measure scores confidentially through Provider Preview Reports.
The change impacts the data used in HHA iQIES reports and future public reporting, necessitating that HHAs ensure accurate documentation to align with the new measure specifications and avoid discrepancies. It will be important for HHAs to update their internal documentation and coding practices, especially for OASIS items J1800 and J1900, to ensure compliance with the new definitions, and develop strong systems for identifying and reporting falls with major injury.
HHAs should be anticipating the potential future addition of the respecified FMI measure to the Expanded HHVBP model measure set in future rulemaking and be preparing for a potential heightened survey focus on accurate falls with major injury reporting. CMS will be responsible for monitoring the accuracy of the FMI quality measure to help ensure HHAs submit required OASIS assessments when their patients are hospitalized and report falls with major injury.
As we all know, OASIS reporting accuracy is critical. MatrixCare can help prepare and support your clinicians for the critical assessment changes occurring in our industry.
See how MatrixCare can support your team with CMS changes.
Brandy Shifteh
Brandy Shifteh joined MatrixCare in 2018 as a Clinical Informatics Analyst and transitioned to the role of Regulations Compliance Manager for home health in 2019; responsible for the monitoring and analysis of regulatory requirements to support compliance in our products and services.
Brandy is a registered nurse with over 30 years of leadership and consultant experience in the home health, hospice, and private duty home care sector, with extensive experience in operations management, regulatory compliance, clinical program development, accreditation/survey preparedness, and revenue recovery. She is very plugged in to the regulatory community, with relationships at both the state and federal level, and serves as an active member on several industry and national association advisory councils.
Brandy holds undergraduate degrees in nursing and health services administration, and an MBA in computer information systems.
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