September 25 2025
OASIS Answers
Categories: HHQRP

Experts Give CMS Insights on Measuring Falls in Home Health 

by Kerry Termine, DPT, HCS-D, COS-C

The Falls with Major Injury quality measure is a cross-setting measure that aims to identify the percentage of patient stays or episodes in which a patient has had a fall that resulted in a major injury.

In part 2 of this series, we explore the FMI May 2025 TEP Report. Read about the Falls with Major Injury (FMI) Quality Measure, its heightened importance, and its pending changes in part 1.

As discussed in Part 1 of this 2-part blog series, in response to the 2023 OIG report on the Falls with Major Injury (FMI) measure, 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 assessment-based data (OASIS in home health) to use both assessment-based data and claims data.

In May 2025, CMS held a second TEP. The May 2025 TEP 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.

The May 2025 TEP agreed that if an assessment indicated there was no evidence of a fall with major injury that the claims data would then be used for the identification of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses that indicated the patient had a major injury and/or fall. If there was evidence of at least one of the ICD-10-CM diagnoses indicating a major injury found on the claim, that patient stay or episode should be triggered for the measure.

In addition to this decision, CMS asked for TEP input on the definition of “major injury” being broadened to include the ICD-10-CM categories:

Fracture (Traumatic)
Joint Dislocation/Subluxation (Traumatic)
Injury to the Head (with and without Loss of Consciousness)
Other Non-Fracture Bony Injury
Organ Trauma
Crush Injury
Spine (Cord/Disc)

The general consensus from the TEP was that diagnoses in these categories should be included for all body systems but only for the initial encounter ICD-10-CM diagnosis code. The TEP recommended that pathological fractures and injuries that more closely met the definition of “injury (except major)” should be excluded from the new definition of a FMI.

CMS also received consensus from the TEP on a list of ICD-10-CM external cause codes that could appear on a claim to indicate a fall had occurred.

Following the TEP, the CMS Measure Development Team said they would take the feedback from the TEP and use it to refine the ICD-10-CM diagnoses that constituted a “major injury” as well as any necessary measure exclusions. They also would refine the measure specifications to include claims-data.

What are the next steps for the FMI measure? In the July 2025 Home Health Calendar Year 2026 Proposed Rule, CMS has asked for comments related to the potential addition of the respecified FMI measure to the measure set for the expanded HHVBP Model.

This proposed rule noted that, “CMS is currently working on a respecified version of the FMI measure that uses fee-for-service claims, encounter data, and OASIS data. Using multiple data sources will produce a more robust and complete data set, allowing the respecified FMI measure to be more accurate and include more providers.”

Stay tuned for more updates to the FMI measure specifications! As CMS releases more information, OASIS Answers will help keep you in the know about this important topic!

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