Five-Star Users’ Guide and State-Level Cut Point Tables Updated

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

The Five-Star Technical Users’ Guide was updated October 28, 2020. 

October 2020 revisions include:

Staffing Rating Changes:

Starting with the October 2020 refresh of Nursing Home Compare (NHC), CMS will resume updating PBJ staffing measures and staffing ratings, using the data submitted for the August 14, 2020 deadline (covering April – June 2020). During the time these data are reported on NHC (October – December 2020), facilities that did not report staffing for the August 14 deadline or that reported four or more days in the quarter with no registered nurse will have their staffing ratings suppressed. Their staffing ratings will show “Not Available”. Starting with the January 2021 refresh of NHC, when staffing data submitted by the November 14, 2020 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for July – September 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star. Case-Mix adjustment will be based on the concurrent RUG-IV distribution.

Quality Measure Rating Changes:

Starting with the October 2020 refresh of Nursing Home Compare, a new quality measure (Percentage of residents with pressure ulcers/injuries that are new or worsened) will replace the current short-stay pressure ulcer measure. This new measure is also sometimes referred to by the official measure title of “Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury.” This measure will still contribute between 20 and 100 points to the short-stay QM score. Additional detail is included in the Quality Measure rating section of this document and Table A2. More information about the public reporting of the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measures is available here.

Note that due to the COVID-19 public health emergency, CMS is not currently using any MDS-based or claims-based Quality Measure data after December 31, 2019 for reporting on NHC or in the Quality Measure Rating. CMS will communicate any changes to stakeholders in advance of updating the Nursing Home Compare website.

Health Inspection Rating Changes:

Since the Nursing Home Compare (NHC) refresh in April 2020 and until further notice, the health inspection domain of the rating system is being held constant to include only data from surveys that occurred on or before March 3, 2020. Results of health inspections conducted on or after March 4, 2020, will be posted publicly, but not be used to calculate a nursing home’s health inspection star ratings.

CMS will continue to monitor inspections, including the restarting of certain inspections (i.e., surveys) per CMS memoranda QSO-20-31-ALL and QSO-20-35-ALL. CMS will restart the inspection ratings as soon as possible and will communicate any changes to stakeholders in advance of updating the Nursing Home Compare website.

The Five Star Quality Rating System State-Level Cut Point Tables were also updated on October 28, 2020.