Upcoming Changes to Nursing Five-Star Quality Rating System
CMS released QSO-25-20-NH on June 18, 2025, announcing updates to Nursing Home Five-Star Quality Rating System.
CMS is making key changes to the Nursing Home Five-Star Quality Rating System that will impact how your health inspection rating is calculated starting this month. These updates emphasize recent survey performance and add new risk adjustors tied to resident functional status. With increased weight on current data, SNFs will need to sharpen their focus on survey readiness, quality improvement, and accurate reporting. Below is a summary of what’s changing and how SimpleAnalyzer™ will help you stay aligned.
How Does This Impact Me?
Effective with the July 2025 refresh, CMS is implementing a change to the methodology for calculating the health inspections domain, shifting from using the three most recent standard health inspection surveys to the two most recent standard health inspection surveys to calculate health inspection ratings. CMS will continue to use a three-year lookback period for complaint and infection control inspections.
By eliminating Cycle 3 and giving the most recent survey and complaint/infection data a 75% weight, facilities that maintain consistently high standards of care are rewarded.
The most immediate impact will be on how teams approach regulatory readiness and continuous quality improvement:
- Survey Preparation: With greater emphasis on recent data, teams must maintain heightened vigilance in documentation, infection control, and complaint management year-round.
- Performance Monitoring: Quality assurance and performance improvement (QAPI) activities should incorporate the new rating weights and reporting features to ensure alignment with CMS expectations.
- Staff Training: Education on the updated inspection calculator, deficiency filters, and reporting requirements will be crucial to ensure all staff understand their role in maintaining compliance and driving quality care.
- Resident and Family Communication: Enhanced transparency means facilities should be proactive in sharing updates and addressing questions from residents and their families regarding changes to ratings and quality measures.
CMS is also updating the risk-adjustment models for the four claims-based measures to add risk adjustors using variables from Section GG (resident’s functional ability) in the Minimum Data Set (MDS). To minimize the impact of this change, CMS is revising the thresholds for the claims-based measures to maintain the same distribution by points based on data from the April 2025 refresh.
What’s Changing in SimpleAnalyzer™? (Target Release Date: July 30, 2025)
- Inspection Rating Algorithm
- Cycle 3: Removed from the calculation.
- Cycle 1 (75%): Most recent standard survey + complaint/infection data (last 12 months)
- Cycle 2 (25%): Previous standard survey + complaint/infection data (prior 2 years)
- Complaint/Infection Weighting:
- Year 1: 75%
- Years 2 & 3 (combined): 25%
- Five-Star Health Inspection Calculator UI
- Cycle 3: Removed from display
- New 'Year' Column: Added between Revisit and Complaint
- Updated tooltips: Explain new weights and logic
- Deficiency Details Enhancements
- Dynamic counts: Real-time counts showing the total number of deficiencies broke down by type (e.g., 5 standard, 2 complaints)
- New filter: Survey Deficiency Type (All, Standard, Complaint/Infection)
- Updated filter: Cycle 1 / Year 1, Cycle 2 / Years 2 & 3
Looking Ahead
Upcoming Antipsychotic Measure Revision (Effective October 29, 2025)
CMS will revise the long-stay antipsychotic measure to include Medicare and Medicaid claims data alongside MDS. This aims to improve accuracy in identifying residents receiving antipsychotics. We’ll share more details and software updates to support this change soon.
Reference: Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide July 2025
Staying Ahead of the Changes
These Five-Star updates place greater weight on your most recent survey and quality data, rewarding consistency and raising the bar for ongoing readiness. SimpleAnalyzer™ will reflect these changes starting July 30, helping your team stay proactive and aligned with CMS expectations. If you have questions, please reach out to our Support Team.