fbpx

< Back to Thought Leadership

Five-Star Quality Rating System: Changes Your Nursing Facility Needs to Know

On July 7, 2022 the Center for Medicare and Medicaid Services (CMS) released the updated Nursing Home Five-Star Quality Rating Technical Users’ Guide with the methodology for the changes to the Staffing Rating and the Overall Quality Rating. Here is what your facility needs to know.

Changes to the Staffing Rating

CMS is basing the new staffing rating on six different staffing measures, as seen in the table below. Points are assigned to each of the six staffing measures. For all of the measure except administrator turnover the points are determined based on deciles. The facility receives more points for higher case-mix adjusted staffing levels.

These staffing hours come from the hours reported on the Payroll-Based Journal (PBJ) System. Points from each of the six measures are added together, and then the total staffing score is compared to the staffing rating point thresholds to assign a rating of one to five out of five stars.

The point ranges for the Staffing Rating is as follows, with a maximum possible score of 380 points.

  • 1 Star: <155 points
  • 2 Stars: 155-204 points
  • 3 Stars: 205-254 points
  • 4 Stars: 255-319 points
  • 5 Stars: 320-380 points

Changes to the Overall Quality Rating

CMS is also revising how assigning overall quality star rating is determined. In previous years, nursing facilities that had a four- or five-star staffing rating would also get an additional star in its facility’s overall star rating. Beginning in July 2022, only nursing facilities with a five-star rating in staffing will get the additional increase in its overall star rating.

Contact Blue

Consumers are increasingly using Care Compare as a tool when choosing a nursing home for their loved ones. Non-consumers are using the ratings for financial loans, insurance contracts, network referrals, and incentive payments. Does your nursing facility need help understanding the changes to the Nursing Home Five-Star Quality Rating System and what the changes actually mean for your facility?

Contact your local Blue & Co. Advisor or a member of our Post-Acute Care team, and we can assist you with understanding the new CMS changes, projections, and help your facility identify areas of missed opportunities.

Landon Hackett, CPA, MSA, Director
317.713.7929

Stephanie Fitzgerald RN, RAC-CTA, CPC, Manager
502.992.2582

Share this article

interest rate swaps

New Year, New Rates: How Not-For-Profits Can Lock in Stability with Interest Rate Swaps

By Annmarie Novotney, CPA, Audit Director at Blue & Co. Over the past few years, not-for-profits have faced heightened interest rate volatility. In 2022 and 2023, the Federal Reserve raised […]

Learn More
CMS Finalizes 2026 OPPS Rule: Preparing for Market-Driven MS-DRG Reporting

CMS Finalizes 2026 OPPS Rule: Preparing for Market-Driven MS-DRG Reporting

In our last thought leadership, we gave an update on new pricing transparency rules.  Within the same rule, CMS requires a new cost report worksheet that utilizes the new pricing […]

Learn More
SNFs in 2026: Preparing for Audits, Surveys, and Value-Based Care

SNFs in 2026: Preparing for Audits, Surveys, and Value-Based Care

What to Expect from CMS in 2026 As we close out 2025 after a year of regulatory challenges, Skilled Nursing Facilities (SNFs) enter 2026 amid evolving CMS rules, heightened compliance […]

Learn More
Share this article
Share this article