CMS Announces Significant Updates To The Five Star Rating System

CMS Announces Significant Updates To The Five Star Rating System

These changes will be effective April 24, 2019. Here are some highlights:

Health Inspection:

The most significant change is the ending of the ‘freeze’ which has been in place since last February. This was put in place following the implementation of a new inspection process. Previously, the health inspection rating was based on inspections conducted prior to November 28, 2017. Starting in April, it will again be based on the three most recent inspection cycles, including those conducted after November 28, 2017. A greater weight given to the more recent inspections, as was the case prior to the freeze.

Quality Measure:

There will be the addition of separate short stay and long stay quality measure ratings, there will continue to be an overall quality rating which will be used to calculate the overall five star rating.

The thresholds used in the quality domain have also been increased, in line with the improving trends on these measures. Going forward, every six months the thresholds will be increased by half of the overall rate of improvement.

There are several changes in terms of the long stay measured being used in the quality domain. A long-stay hospitalization measure and a long-stay emergency department transfer will be added. The percentage of long-stay residents who were physically restrained measure will be dropped from the five star calculation, as the use of restraints has been very low for the last few years, the measure will continue to be reported on the Nursing Home Compare website.


The weighting for RN staffing, relative to total staffing, has been increased.

The number of days without an RN that automatically result in a one star in staffing has been reduced from seven to four.

For more details please see the updated Five Star Technical users’ guide, along with the memorandum from CMS.

If you have any questions, please feel free to contact Chris at