Five Star Updates

The Centers for Medicare & Medicaid Services (CMS) recently released the October 2020 version of the Five-Star Quality Measure System Technical Users' Guide. It includes several revisions and updates for the Staffing, Quality Measure, and Health Inspection ratings in response to the Public Health Emergency (PHE).


Health Inspection

Since the Nursing Home Compare (NHC) refresh in April 2020 and until further notice, the health inspection domain of the rating system is being held constant to include only data from surveys that occurred on or before March 3, 2020.

Results of health inspections conducted on or after March 4, 2020, will be posted publicly but not be used to calculate a nursing home's health inspection star ratings.

Quality Measures

As of the October 2020 refresh of Nursing Home Compare, a new quality measure Percentage of residents with pressure ulcers/injuries that are new or worsened will replace the current short-stay pressure ulcer measure. This measure will still contribute between 20 and 100 points to the short-stay QM score.

Note that due to the PHE, CMS is not currently using any MDS-based or claims-based Quality Measure data after December 31, 2019 for reporting on NHC or in the Quality Measure Rating. At this time, the Quality measure domain will be held constant.


As of October 2020, refresh CMS resume updating PBJ staffing measures and staffing ratings, using the data submitted for the August 14, 2020 deadline. Facilities that did not report staffing for the August 14 deadline or 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".

Starting with the January 2021 refresh of NHC, when staffing data submitted by the November 14, 2020 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for July – September 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star. Case Mix adjustments will continue to be based on RUG-IV.


For now, facilities' Health Inspection and Quality Measure domains are being held constant until further notice due to the impact that Covid-19 PHE. However, the staffing domain is active. In January 2021, Five-Star report facilities can expect to see only the staffing domain update with the most recent submitted data. CMS reminds providers, "We will communicate any changes to stakeholders in advance of updating the Nursing Home Compare website."

The updated Five Star Quality Rating System Users' Guide can be found at