New training on respecified falls measure

Effective Apr 21, 2026

Published Apr 21, 2026

Last Reviewed Apr 21, 2026

CMS is offering a new online course detailing updates to the respecified Falls With Major Injury (FMI) quality measure.

Changes effective Jan. 1, 2026, expanded the collection points used to determine this score after an Office of Inspector General report found home health agencies underreporting FMI incidents.

Previously based solely on falls reported in the OASIS, the measure now includes falls reported in claims and encounter data from hospital stays and emergency room visits.

If a fall is reported on the OASIS with no major injury, CMS will look to see if the patient had a hospital or ED stay with a major injury coded. An example would be a traumatic bone fracture or joint dislocation.
When no fall is reported on the OASIS, CMS will look to see if the patient had a hospital or ED stay with a major injury coded, but it will require an additional External Cause code indicating a fall before being reported as an FMI for the agency.

This will mean that many agencies will eventually see an increase in their FMI score on Care Compare.

At the same time, CMS has also updated its guidance around responding to the falls questions in the OASIS:

A fall due to an overwhelming force (e.g., a patient pushing another patient) is considered a fall.
If a major injury results from a fall or an intercepted fall that occurs when a clinician is intentionally challenging a patient’s balance during balance training, it would be reported as both a fall and a major injury in J1800 (Any Falls Since SOC/ROC) and J1900 (Number of Falls Since SOC/ROC).
For J1900, injuries that aren’t considered major include, but are not limited to, skin tears, abrasions, lacerations, superficial bruises, hematomas and sprains; or any fall-related injury that causes the patient to complain of pain.
For J1900, injuries that are considered major include, but are not limited to, traumatic bone fractures, joint dislocations or subluxations, internal organ injuries, amputations, spinal cord injuries, head injuries and crush injuries.
Fractures confirmed to be pathologic (vs. traumatic) are not considered a major injury resulting from a fall.

Find CMS training on the updated FMI measure at https://www.cms.gov/.../home-health-quality-reporting-training.

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