Changes to the CMS 5-Star Rating System: What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) has initiated the next phase of its effort to enhance transparency regarding nursing home operations and ownership. The updates announced in June concentrate on the Five-Star Quality Rating System and include changes to the health inspection domain, data collection and evaluation, as well as public access to information.
EFFECTIVE JULY 30, 2025:
Dropping Third Cycle Standard Health Inspections:
- Removing the oldest survey and using only the two most recent surveys for health inspection ratings.
*According to CMS, the third cycle inspection may not reflect current nursing home performance, given their age.
*LeadingAge PA Analysis: With CMS’s decision to drop the third inspection cycle for the 5-Star Reports, this helps ensure the health inspection rating reflects more recent performance and current quality of care. If a provider has experienced quality challenges in the third inspection cycle but has taken significant steps in improving, that third inspection cycle will no longer negatively impact the survey rating because the two most recent cycles will be considered. It is important to note that the cycle one survey will now be weighted by ¾, with the cycle two survey being weighted by ¼.
Making Performance Data More Accessible:
- Share in a consumer-friendly format information for each group of Medicare-certified nursing homes linked by common owners and operators (affiliated entities). Information includes average overall star ratings, health inspection results, staffing levels, and quality measure ratings.
*LeadingAge PA Analysis: Now, when the consumer references the Nursing Home Care Compare website to view a nursing home’s 5-star data, they will be able to review performance information for the affiliated entity. This consumer-friendly format makes the information of the affiliated entity more accessible.
Removing COVID-19 Vaccination Data from Main Profile Pages:
- Taking off staff and resident vaccination rates from the main profiles of each nursing home on Care Compare.
*According to CMS, this aims to shift focus from pandemic metrics to long-term quality indicators.
EFFECTIVE OCTOBER 29, 2025:
Antipsychotic Medications:
- Updating the quality measure by adding Medicare and Medicaid claims, plus Medicare Advantage encounter data, to supplement existing Minimum Data Set (MDS) data for long-stay residents on antipsychotics.
*LeadingAge PA Analysis: CMS projects the percentage of residents receiving antipsychotic medications is 14.64% under the current measure. With these changes that will take effect in October, CMS foresees this measure will increase to 16.98% due to the inclusion of additional data being reported.
As LeadingAge PA members, all NHAs receive 5-star reports each quarter and have access to custom training on how to interpret these reports and use them to increase star ratings.