CMS Announces Changes to Five-Star Quality Rating System

Lisa Volk and Jackie Pappalardi in Clinical & Quality

On October 23, the Centers for Medicare & Medicaid Services (CMS) will make several changes to the Nursing Home Compare website and the Five-Star Quality Rating System. These changes will affect the health inspection and quality measure (QM) domains for skilled nursing centers.  

Yesterday, CMS announced that they will be adding an alert icon on Nursing Home Compare to centers that have been cited for abuse and neglect. We estimate approximately 750 facilities will receive this icon. For more information, read yesterday's member email here

Today, CMS published updates to the Five-Star Technical Users' Guide stating that centers that receive the abuse icon will have their health inspection rating on Nursing Home Compare capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility flagged for abuse can have is four stars.  

In addition, CMS will be removing two quality measures from the Five-Star Quality Rating System. These measures are: 

  1. Percentage of short-stay residents who report moderate to severe pain. 
  2. Percentage of long-stay residents who report moderate to severe pain. 

As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings will change starting later this month. These changes will overall maintain the same distribution of short-stay and long-stay QM ratings that were posted on Nursing Home Compare in July 2019. The new cut-points are shown in the table below.  

Point Ranges for the QM Ratings (as of October 2019) 

 

 

 

 

 

 

 

 

AHCA will keep you informed on any further developments. If you have any questions, please contact the AHCA Regulatory team at regulatory@ahca.org.  

NYSHFA/NYSCAL CONTACTS:

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Jackie Pappalardi, RN, BSN
Director, Educational Development & Grant Mgmt.
518-462-4800 x16