Nursing Home Health Inspection Rating & Quality Measure Ratings for NHC to Be Unfrozen

The Centers for Medicare & Medicaid Services (CMS) issued a QSO Memo on December 4, 2020 which alerts providers to upcoming changes to the Five-Star Quality Rating System and Nursing Home Compare. Due to the COVID-19 Public Health Emergency (PHE), CMS made many changes to the survey process and requirements for providers, including a multitude of blanket waivers* for things like MDS submissions and staffing data submission through the Payroll-Based Journal (PBJ) system. These changes impacted the Agency’s ability to calculate the Five-Star Quality Rating and update Nursing Home Compare as usual, however, these regulatory burdens have slowly been coming back into place.

In June 2020, CMS announced that the waiver for staffing data submission through the Payroll-Based Journal (PBJ) was ending immediately. The emergency waiver had resulted in the Staffing Domain of the Five-Star Quality Rating System not being updated as scheduled in April 2020, and the termination of the waiver led to an update of the Staffing Domain in the October 2020 Nursing Home Compare refresh. CMS also noted in the June announcement that the Quality Measures Domain was not being held constant, but the Health Inspection Domain would still be held, due to the survey prioritization activities that occurred earlier this year.

Along with the survey prioritization came the implementation of the Focused Infection Control Survey process that had been widely used since its release. On August 17, 2020, CMS announced that it would be returning to normal survey & certification activities. This did not stop the focused infection control surveys from occurring, however, CMS updated the existing Long-Term Care Survey Process (LTCSP) right before Thanksgiving – updates that now incorporate the Focused Infection Control Survey into the LTCSP. CMS had previously indicated that although the Health Inspection Rating was being held, it would be unfreezing that Domain as soon as possible.

That time has come. The new QSO Memo states the following:

  • In line with the above-mentioned announcement regarding the return to usual S&C activities, CMS has instructed State Survey Agencies (SSAs) to resume all survey activities as soon as they have the necessary resources to do so (i.e., PPE and staff).
  • CMS will begin calculating Nursing home Health Inspection Ratings again on January 27, 2021.
  • CMS believes that it is important to provide transparency to stakeholders regarding nursing homes’ performance on Focused Infection Control Surveys, so findings from the Focused Infection Control Surveys will be used in calculating the Health Inspection Rating. These surveys have been categorized as Complaint Surveys throughout the PHE and will be included in the calculation the same way all other Complaints are.

The QSO Memo also states that the Quality Measures data will be posted on Nursing Home Compare and used in the Five-Star Quality Rating System and will be updated on January 27, 2021 as well. CMS states that updating this information will provide a two-fold outcome. First, the posting will incentivize nursing homes to improve their performance. Second, this information will provide stakeholders – in particular residents and their families – with information regarding the “current status” of nursing home residents.

Nursing Home Compare is Now Care Compare

Don’t forget, as of December 1, 2020, CMS streamlined and incorporated all of the existing healthcare compare tools into one side. This has not changed the information that is available about nursing homes or the calculation methodology but is meant to provide a more user-friendly experience to consumers.

For full details, view the December 4, 2020 CMS QSO Memo, “Updates to the Nursing Home Compare website and Five Star Quality Rating System” (Ref: QSO-21-06-NH).

*The list of blanket waivers is continually updated. The most current update from 12/1/2020 can be found here.


CMS Compliance Group, Inc. is a regulatory compliance and quality improvement consulting firm. Our interdisciplinary team of consultants are available to help your organization achieve and maintain compliance with regulatory requirements. Whether you are preparing for survey, need Plan of Correction assistance, have received a Directed Plan of Correction or Directed Inservice, or need assistance with removing an Immediate Jeopardy, CMSCG is here to assist. Please contact us below or call us at 631.692.4422.

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