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Clarification to the “Freeze” of the Health Inspection Star Ratings

A November 2017 memo from the Centers for Medicare and Medicaid Services (CMS) announced that the current health inspection star ratings would be held constant on the Nursing Home Compare website for any surveys occurring between Nov. 28, 2017 and Nov. 27, 2018. This has been portrayed as a "freeze" in health inspection 5-Star ratings. LeadingAge NY and LeadingAge National have confirmed with CMS that nursing homes’ health inspection 5-Star ratings can change during this time period.

Most facilities will be surveyed for compliance with Phase 2 Requirements of Participation (RoPs) using the revised survey process within one year after the Nov. 28, 2017 Phase 2 implementation date. Due to the differing standards and process between those facilities surveyed under the old and new survey processes, CMS agreed to not include in the health inspection star rating any health inspections or complaint investigations occurring during the period Nov. 28, 2017 – Nov. 27, 2018.

Further, during this period, the health inspection star rating will no longer use the third (oldest) cycle of health inspection survey and complaint investigation data in a nursing home’s health inspection score. As a result, the weighted health inspection score and star rating for all nursing homes will be based on the two most recent cycles of survey data (i.e., the oldest cycle is dropped from the health inspection score because of its age, as part of the normal update process). This change will also occur in early 2018 for all facilities. At that time, the most recent cycle of survey data will be weighted at 60 percent, and the prior cycle of data will be weighted at 40 percent.

CMS has clarified that when the health inspection scores are recalculated early this year using the two cycles of data, most facilities will experience a change in their weighted health inspection scores. Each month, CMS recalibrates the "cut points" that set the thresholds for assigning the health inspection scores to each 5-Star rating level. Consequently, while most facilities are unlikely to see their health inspection star ratings change during 2018, it is possible that some facilities will see changes, which could be positive or negative.

CMS will be updating the Five Star Quality Rating System Technical User’s Guide to reflect these changes. CMS will continually monitor survey activity during the one-year period to determine if any changes to the methodology need to be made.

Contact: Mary Wassel, mwassel@leadingageny.org, 518-867-8850