Update - Five Star Rating System Changes

In October 2014, President Obama issued an executive action instructing the Centers for Medicare and Medicaid Services (CMS) to make changes to the Five Star rating system. CMS announced the first of these changes on February 12th.  Of the three parts of Five Star – survey, quality measures (QM), and staffing – CMS will make changes to the staffing component and to the quality measure component. The staffing component no longer allows centers with three or fewer stars on both RN and direct care staff to get a four star rating on the staffing component. The quality measure component adds two new quality measures (a long stay antipsychotic measure and a short stay antipsychotic measure) and rescales the cutpoints used to classify centers into the five QM Five Star ratings. These changes not only impact a center’s ratings on the staffing and QM components but will impact a center’s overall ratings as well (A link to AHCA’s PowerPoint is included for your reference).

Tomorrow, (February 20) CMS is expected to announce new facility ratings based on these changes.  AHCA is “estimating” that in Virginia, approximately 29 percent of facilities will lose one star, and approximately 2 percent may lose two stars relative to current ratings.  The remaining 69 percent of facilities are expected to remain the same.

AHCA has created a number of resources, including media talking points, for facilities to utilize in explaining the CMS changes and their effect on the Five Star ratings.  These materials can be accessed here.  Additionally, attached you will find a summary from Lyn Bentley, AHCA, Sr. Director of Regulatory Services describing the changes in the Five Star as well as a discussion of the MDS Staffing Focused Survey.  Lyn also provided the documents from CMS that provide an update on MDS Focused Staffing Surveys and the MDS Focused Survey Pilot Findings along with a memo to state survey agency directors on the changes to the five state ratings system.