CMS Releases Updated Five Star Quality Ratings for Care Centers

Posted on January 27, 2021 by Jonathan Lips

The Centers for Medicare and Medicaid Services (CMS) today released updated Five-Star quality ratings for care centers. Beginning with this month’s update, all three domains (Survey, Staffing, and Quality) will again operate as they did prior to the COVID-19 pandemic. All care centers should review the new ratings posted at Medicare Care Compare. As described in this revised Technical Users’ Guide, updates to the specific domains are as follows:

Health Inspections Domain

The most significant change is that the health inspection rating freeze has ended and includes surveys after March 3, 2020. For survey scoring purposes, deficiencies found during focused infection control surveys will be treated as complaint deficiencies. This means they will contribute to the overall points accumulation, and they will count more towards a survey score and rating during the immediate 12 months following the deficiency citation before gradually reducing in impact. CMS has also posted updated state-level cut point tables.

Quality Measures Domain

The quality measures domain rating, which was not held constant as health inspections were, will continue to update. For January 2021, CMS used data for July 2019 - June 2020 for all of the measures that were updated. The two QMs that are part of the Skilled Nursing Facility Quality Reporting Program (Percentage of SNF residents with pressure ulcers/pressure injuries that are new or worsened and Rate of successful return to home and community from a SNF) are not being updated at this time.

Staffing Domain

The staffing domain rating was updated last quarter and continues to update. For January 2021, facilities that did not report staffing for the Nov. 14, 2020 deadline or that reported four or more days in the quarter with no registered nurse will have their staffing ratings suppressed. Their staffing ratings will show “Not Available” with the January, February, and March refreshes. Starting with the April 2021 refresh of Care Compare, when staffing data submitted by the Feb. 14, 2021 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for October – December 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star.

What This Means for Providers

As each of the 3 domains updates, providers may see changes to their domain ratings and overall Five Star Quality Rating system rating. Like prior Five-Star Rating updates, there will be some facilities who see their ratings improve and others who see their ratings decrease. Additionally, related programs, such as the Special Focus Facility (SFF) program and the Consumer Alert Icon (“abuse icon”) will be updated. Providers may find themselves newly included or excluded from these special designations, including the SFF candidate list.

We will analyze and share the impact of these changes as more information becomes available. LeadingAge New York will generate updated Quality Rating reports based on the new data, and we will share those facility-specific reports with members as soon as they are available.