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Changes to staffing rating thresholds in 5-star rating system update

CMS announced April 2019 updates to the Nursing Home Compare website and Five-Star Quality Rating System, including a change to staffing rating thresholds, with the staffing level required to receive a 5-star rating determined based on analyses of the relationship between staffing levels and measures of nursing home quality.

The Technical User’s Guide states that, “In recognition of the importance of RN staffing, the method by which the RN staffing rating and the total nurse staffing rating are combined to generate the overall staffing rating is changing to provide more emphasis on RN staffing. Additionally, the overall and RN staffing ratings are set to one star for nursing homes that report four or more days in the quarter with no RN onsite. Finally, staffing ratings are no longer being suppressed for nursing homes that have five or more days with residents and no nurse staffing hours reported.”

The following changes were also made:

  • Health Inspection Domain: The rating methodology for the health inspection rating returned to what it was prior to February 2018. Specifically, results from the three most recent standard health inspections and 36 months of complaint inspections are used to calculate the health inspection score and determine the health inspection rating. Surveys occurring both before and after the implementation of the new survey process (November 28, 2017) are used to determine health inspection scores and rating and are treated in the same way.
  • Quality Measures Domain: The Nursing Home Compare website reports separate ratings for short-stay quality of resident care and long-stay quality of resident care in addition to an overall quality of resident care rating. Measures of long-stay hospitalizations and long-stay emergency department (ED) visits were added to the quality measure rating, and the long-stay physical restraints measure was dropped from the quality measure rating. The scoring rules for the quality measures changed to give more weight to measures with greater opportunity for improvement. Given the changes in measures and weights, there are also new point thresholds for the overall quality measure rating as well as the short-stay and long-stay ratings.
  • Special Focus Facilities: Nursing Home Compare no longer displays an overall quality rating or ratings in any domain for nursing homes currently participating in the Special Focus Facility program.

Download the full update here.