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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

Stephanie Fitzgerald RN, RAC-CTA, CPC, Manager

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