Five-Star Quality Rating System


 Five-Star Overview

The Five-Star Quality Rating System is a tool to help consumers select and compare skilled nursing care centers. Created by the Centers for Medicare & Medicaid Services (CMS) in 2008, the rating system uses information from Health Care Surveys (both standard and complaint), Quality Measures, and Staffing. The Care Compare website​​​ features the rating system. 

Today, the Five-Star Rating System has expanded beyond consumer use. Non-consumers, such as state regulators, health care insurers, lenders and investors, use Five-Star to determine incentive payments, referral networks, and financial loans.

CMS is continuously working to improve the program. For example, on March 5, 2019, CMS announced several changes. These changes included updated thresholds for assigning stars (or moving the “goal posts” back) for both the staffing and quality components of the system that caused significant changes.

Timeline Highlights

  • October 2014: The President issued an executive action instructing CMS to make changes to the system.
  • February 13, 2015: CMS announced changes to the Five-Star Quality Rating System that impacted how CMS assigns stars for both the Staffing and Quality Measure components. 
  • March 3, 2016: CMS announced the addition of new Quality Measures on Nursing Home Compare and Five-Star. They appeared on Nursing Home Compare in April 2016 and incorporated into Five-Star in July 2016.
  • November 24, 2017: CMS freezes the Survey component of Five-Star to accommodate the new survey process
  • April 6, 2018: CMS announced the transition to using Payroll-Based Journal (PBJ) for the Staffing component of Five-Star
  • March 5, 2019: CMS announced lifting of the Survey freeze, adding separate ratings for short- and long-stay quality measures, and adjusting the staffing and quality thresholds.
  • April 24, 2020 & June 25, 2020: CMS announced and updated accommodations to the Five-Star rating system to account for the disruption caused by COVID-19 Public Health Emergency, such as freezing the Survey component.
  • December 4,2020: CMS announced​ it will resume calculating nursing homes Health Inspection and Quality Measure ratings on January 27, 2021.
  • September 20, 2023: CMS announced the freezing of the following four measures starting in April 2024 because of the MDS transition from Section G to GG on October 1, 2023.​
    • Percentage of Residents Who Made Improvements in Function (short-​stay)
    • Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (long-stay)
    • Percent of Residents Whose Ability to Move Independently Worsened (long-stay)
    • Percent of High-Risk Residents with Pressure Ulcers (long-stay)
CMS Memo Confirms PBJ Submission Deadline and Provides Five-Star Updates
On June 25, CMS released a QSO memo updating changes to the staffing and quality domains of Five-Star due to COVID-19. Read More

Five-Star/Nursing Home Compare (NHC) updated January 29
NHC is usually updated the fourth Wednesday of every month, but the updates on the first month of the quarter (i.e. January, April, July, October) are more noteworthy. They include updated quality and staffing data. Other monthly updates only include updated survey data. Read More

Updated Five-Star Quality Measure Predictor Tool Released on LTC Trend Tracker
Starting December 19, LTC Trend Tracker users have access to a tool that shows what is determining their Five-Star Quality Measure ratings and how they can improve. Read More
 AHCA members can access all resources on ahcancalED.

Track your data to gain insight into how to increase your star ratings. Member login required.