October 2020 Update – CMS Five-Star Quality Measure System Technical Users’ Guide

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, including:

Staffing Rating

CMS completed its October 2020 Nursing Home Compare data refresh on October 28, 2020. Providers will now see that Payroll-Based Journal (PBJ) data has been included. CMS had announced in a June 25, 2020 QSO Memo that it was terminating the blanket emergency waiver for submitting staffing data through PBJ. As a result, facilities were notified that they were required to submit staffing data through the PBJ system by August 14, 2020 for Calendar Quarter 2 (April-June 2020) and then this data would be used for the October 2020 refresh.

  • Any facility that did not report staffing for this time period (April 2020-June 2020) by the August deadline or that reported four or more days in the quarter with no RN now have their staffing ratings suppressed and will be listed as “Not available.”
  • The next deadline for PBJ submission is November 14, 2020 for the period of July 2020-September 2020. This data will be used for the January Nursing Home Compare data refresh. If a facility does not report staffing data for July-September 2020, or reports four or more days in the quarter without an RN, its staffing rating will be reduced to 1 star.

Quality Measures

Changes have also been made for the Quality Measures ratings now that the October 2020 refresh has been completed, including:

  • A new QM, Percentage of residents with pressure ulcers/injuries that are new or worsened has replaced the existing Short Stay pressure ulcer QM.

CMS notes that it is not using any MDS-based QM data or Claims-based QM data after December 31, 2019 for reporting on Nursing Home Compare or in the QM Rating. When it plans to update NHC, it will let providers know in advance.

Health Inspection

Here is what to know about the Health Inspection Rating:

  • The Health Inspection domain continues to be held constant and only reports on data from surveys that occurred on or before March 3, 2020, which is when CMS announced changes to survey prioritization.
  • The results of surveys conducted on March 4, 2020 and later are available, but not posted on Nursing Home Compare or used to calculate the Health Inspection star rating.

The Guide states that CMS plans to restart inspection ratings “as soon as possible” and that it is monitoring inspections, including ensuring that certain inspections are being completed based on the survey prioritization information included in earlier QSO Memos.

View the October 2020 Technical Users’ Guide (updated 10/28/2020 for more details).

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