Kusserow on Compliance: CMS announced updates to nursing home ratings

CMS announced updates in April 2019 to Nursing Home Compare and the Five-Star Quality Rating System. Its purpose is to provide tools for consumers to compare quality between nursing homes. This comes in advance of the November 28, 2019 deadline for skilled nursing facilities and nursing homes to have implemented an effective compliance and ethics program as a condition of participation in the Medicare and Medicaid programs. The new tools announced have been created to help consumers, their families, and caregivers compare nursing homes and identify areas they may want to ask about when looking at nursing home care. Nursing Home Compare has a quality rating system that gives each nursing home a rating between 1 and 5 stars and those with 5 stars are considered to have above average quality and nursing homes with 1 star are considered to have quality below average. There is also a separate rating for each of the following three factors:


  1. Health Inspections include findings on compliance to Medicare/Medicaid health and safety requirements from onsite surveys conducted by state survey agencies at nursing homes.
  2. Staffing Levels are the numbers of RNs available to care for patients in a nursing home at any given time.
  3. Quality Measures for care are based on resident assessment and Medicare claims data.


The April 2019 changes include revisions to the inspection process, enhancement of new staffing information, implementation of new quality measures, and lifting of the “freeze” on the health inspection ratings instituted in February 2018 to hold up the star rating score until all nursing homes were surveyed at least once under the new survey process. In April, users of the site will be able to see the most up to date status of a facility’s compliance, which is a very strong reflection of a facility’s ability to improve and protect each resident’s health and safety. CMS is also setting higher thresholds and evidence-based standards for nursing homes’ staffing levels, recognizing that nurses have the greatest impact on the quality of care nursing homes deliver. As such, CMS is assigning an automatic one-star rating when a Nursing Home facility reports no RN is onsite. In April 2019, the threshold for the number of days without an RN onsite in a quarter that triggers an automatic downgrade to one-star will be reduced from seven days to four days. The new Update includes:


  • changes to the quality component to improve the identification of quality differences among nursing homes, raising expectations for quality, and incentivizing continuous quality improvement;
  • adding measures of long-stay hospitalizations and emergency room transfers;
  • removing duplicative and less meaningful measures;
  • establishing separate quality ratings for short-stay and long-stay residents; and
  • revising the rating thresholds to better identify the differences in quality among nursing homes making it easier for consumers to find the information needed to make decisions.


Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2019 Strategic Management Services, LLC. Published with permission.