June 26, 2020

CMS Announces Changes to 5-Star Rating System; End of Staffing Submission Waiver

BY Jodi Eyigor

In a policy memo on June 25, CMS announced temporary changes to the 5-star rating system on Nursing Home Compare. These changes include freezing pieces of the staffing and quality measures domains, as well as the immediate end to the PBJ staffing submission waiver. These changes are discussed in greater detail below.


In March 2020, CMS waived requirements at 42 CFR 483.70(q) related to submissions of staffing data through the payroll-based journal system. This data is used to calculate the staffing domain rating on Nursing Home Compare and updates on a quarterly basis. The staffing ratings currently reflected on Nursing Home Compare are based on data from calendar quarter 4 2019 (October – December). The next scheduled update for this domain, July 2020, would rely on data collected for calendar quarter 1 2020 (January – March), the submission of which was waived. As a result, the staffing domain measures and ratings for the July update will be held constant.

CMS notes that holding this domain constant denies providers the resolution of penalties, such as the automatic downgrade to a one-star rating that a provider receives when they fail to submit data or when they report more than 4 days in a quarter with no RN on site. For providers in this circumstance, the measures and ratings for the staffing domain will be suppressed with the July update.

Lastly, CMS announces that effective immediately, the waiver of PBJ staffing submission requirements is ending. Providers will be required to resume submission of staffing data through the PBJ system by August 14, 2020. Providers are required to submit data for calendar quarter 2 2020 (April – July). Additionally, CMS encourages providers to submit data for calendar quarter 1 2020 (January – March), though submission of data for Q1 2020 is not required. Staffing domain measures and ratings will next update in October 2020.

Quality Measures

In March 2020, CMS waived requirements at 42 CFR 483.20 related to timelines for submitting the resident assessment (Minimum Data Set, or MDS). This data is used to calculate the quality measures domain measures and rating on Nursing Home Compare. The data collection periods for the individual quality measures vary. Many quality measures would rely on data collected during the waiver period when the domain next updates in July. Therefore, when Nursing Home Compare updates in July, quality measures that are based on a data collection period that currently ends on December 31, 2019 will be held constant. Quality measures that are based on a data collection period that currently ends prior to December 31, 2019 will continue to update until the data collection period end reaches December 31, 2019. Because the waiver will not impact all quality measures in the July update, the quality measures domain rating will be updated as scheduled in July. For more information on data collection periods for quality measures, visit the About the Data page on Nursing Home Compare.

What This Means for Providers

The 5-Star Rating System is about to get even more confusing. The staffing measures and rating will be frozen for a quarter, but the waiver is over. Some quality measures will be frozen, others will not, and the quality measures rating will not be frozen. There is no indication at this time that the MDS submission waiver will end prior to the end of the public health emergency. Recall that the health inspection domain is currently frozen due to the suspension and reprioritization of survey activity; however, survey activity is being reintegrated as states progress through reopening. CMS is monitoring activity and promises to unfreeze health inspections ratings as soon as possible, but has given no indication of when this might be.

Providers should begin getting data in order for the PBJ submission in August. Providers should also check in with their MDS coordinator on those submissions. At this time, the public health emergency is scheduled to end on July 20, 2020, though this may be extended at the discretion of HHS Secretary Alex Azar.

Be sure to check the LeadingAge COVID-19 page regularly for updates, tools, and resources.