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 CMS Five-Star Rating System Changes Await for SNFs in April

One month before changes to the Five-Star Rating system on the Nursing Home Compare website go into effect at the end of April, skilled nursing facilities (SNFs) are focusing on how the revisions announced by the Centers for Medicare & Medicaid Services (CMS) will impact their scores.

The Nursing Home Compare site features a quality rating system that gives each nursing facility a rating of between one and five stars with one overall five-star rating for each SNF, and a separate rating for health inspections, staffing, and quality measures.

Earlier this month, CMS in its “April 2019 Improvements to Nursing Home Compare and the Five-Star Rating System” memo said the following changes will go into effect at the end of April.

--CMS will end the survey freeze on the health inspection domain of the Five-Star program and instead resume the traditional method of calculating the health inspection scores by using three cycles of inspections. Health inspections conducted on or after Nov. 28, 2017, will be calculated into a facility’s overall star rating;

--Nursing Home Compare will start to report separate ratings for both short-stay quality and long-stay quality measures. With the introduction of these separate ratings, the thresholds for quality measures will go up every six months;

--CMS said it is adding two quality measures: long-stay hospitalization and long-stay emergency department visits. Also, the long-stay physical restraints measure will be removed from the quality measure rating. The short-stay pressure ulcer and short-stay discharge community measures currently in place will be replaced with their comparable Quality Reporting Program measures;

--CMS will put a greater emphasis on registered nurse (RN) staffing as it adjusts thresholds for overall staffing ratings. The Five-Star staffing category will now be calculated by figuring the total staffing Hours Per Resident Day (HPRD) and RN Staffing HPRD, with CMS prioritizing RN staffing levels by rounding the Five-Star staffing toward the RN Staffing rating. If, for example, a SNF earns four stars on total staffing and five stars on RN staffing, the average would be 4.5. This number would then be rounded toward the RN rating value and the facility would receive a five for its staffing rating; and

--The agency will deliver a one-star staffing rating to any SNFs that report four or more days without an RN in a quarter. Previously, CMS restricted the Five-Star Staffing and Five-Star RN Staffing to one-star for those facilities with seven or more days in a reporting quarter where there were one or more residents, but no RN staffing hours. This restriction has now been decreased to four or more days in a reporting quarter.

More information is at

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