Regulatory Reminder!

You may have been aware thorough our communication as well as other sources that CMS, earlier this year, indicated that due to the COVID waivers related to MDS submissions and Survey activity the 5-star rating related to both of these domains would be “frozen” until April 2022. Well, not so fast! Late Friday, CMS issues Memo QSO 21-06-NH  which changes that whole expectation. Along with a formal announcement indicating the shuttering of Nursing Home Compare and the implementation of Care Compare, CMS also made two very important announcements (see below) related to the upcoming anticipated refresh of 5-star Data. CMS indicates that, “More details will be posted by January 15th, 2021 in the Five Star Technical Users’ Guide.”


Health Inspection Ratings

Although certain types of inspections were suspended (per QSO-20-20-ALL), CMS has now instructed State Survey Agencies to resume all surveys as soon as they have the resources (e.g., staff and/or Personal Protective Equipment) to do so (see QSO-20-35-ALL). While the COVID-19 PHE has still hindered States’ ability to completely resume all inspections, many states have been able to conduct additional surveys. Additionally, all states have conducted focused infection control surveys in all of the nursing homes in their state.

CMS has always strived to provide updated information about nursing homes’ compliance to consumers, families, and residents. Also, we believe it is important for stakeholders to be aware of nursing homes’ performance on the focused infection control inspections. Therefore, CMS will resume calculating nursing homes’ health inspection ratings on January 27, 2021. Furthermore, findings from the focused infection control inspections will be used to calculate each nursing home’s inspection rating. These findings will be included the same way findings from complaint inspections are used in the Five Star Quality Rating System.

These actions will also automatically result in updates to the Special Focus Facility (SFF) program, including updates to SFF candidates, and facilities’ status for receiving an icon for noncompliance related to abuse.


Quality Measures

As previously mentioned, CMS waived the timeframes that facilities are required to submit resident assessment information through the Minimum Data Set (MDS) per 42 CFR 483.20. We note that while the timeframes for submitting data were waived, nursing homes have still been submitting the required data. Since nursing homes have continued to submit MDS data, the data can be used to update quality measures without any issues. We have also analyzed the data used to support the claims-based quality measures, and similarly, see no issues updating these measures. Therefore, the quality measures posted on the Nursing Home Compare website and used in the Five Star Quality Rating System will be updated on January 27, 2021. This action will not only inform residents and families of the current status of residents in nursing homes, but will also incentivize nursing homes to improve performance. As we progress, CMS will analyze the quality measures for any significant changes, and take any actions needed to improve and protect resident health and safety.


To update the quality measures, CMS will use data based on the data collection period ending June 30, 2020. We note that these updates do not apply to quality measures that are part of the Skilled Nursing Facility Quality Reporting Program (SNF QRP). Presumably that is because the two QRP measures that affect 5-Star ratings, Changes in Skin integrity Post-Acute Care: Pressure Ulcer/Injury, and Claims based: Discharge to Community, have different measurement timeframes than the non-QRP measures.

Have a great day and keep your eyes open for the 5-Star user’s guide on Jan. 15th.