The Centers for Medicare & Medicaid Services (CMS) released memo QSO-23-21-NH on September 20, 2023, outlining changes coming to the staffing and quality measures displayed on Nursing Home Care Compare. With the October 1 implementation of the updated Minimum Data Set (MDS), CMS will transition the case mix methodology used for Care Compare measures from RUGS-IV to a PDPM-based model. This transition impacts staffing level measures and four quality measures:

• 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)

Due to this transition, CMS will temporarily freeze these measures beginning with the April 2024 Care Compare refresh. The staffing level measures will unfreeze with the following quarterly refresh in July 2024, utilizing a PDPM-based case mix methodology going forward. Staffing rating thresholds will be revised to maintain the same overall distribution of points for affected staffing measures.

Quality measures will require more time to adjust. The short stay functionality measure will be replaced by the SNF Quality Reporting Program cross-setting functionality measure and will unfreeze with the October 2024 refresh. The three long stay measures will unfreeze with the January 2025 refresh.

Lastly, CMS has announced new Care Compare policies related to PBJ data submissions. Currently, when a provider fails to submit PBJ data or submits erroneous data, they receive one star for staffing domain rating and the applicable staffing turnover measure is suppressed. Beginning with the April 2024 refresh, nursing homes that fail to submit data or that submit erroneous data will receive the lowest possible score for the impacted turnover measures.

For more information on these changes, refer to the QSO memo and the Nursing Home Care Compare Five Star Quality Rating System Technical Users’ Guide.