Client Advisory: October 2019 Updates to the Nursing Home Compare Website and the Five Star Quality Rating System

On October 7th, 2019, CMS announced abrupt changes to the Five Star Quality Ratings System and the Nursing Home Compare website. The two changes are scheduled to go into effect on October 23, 2019 and include: 1) a conspicuous new warning icon to label facilities with recent survey deficiencies related to abuse and 2) updates relating to the Quality Measures component of the Five Star Quality Ratings System.

New Indicator for Facilities with Survey Deficiencies Related to Abuse

CMS has frequently expressed a commitment to preventing instances of abuse, neglect, and exploitation of residents in nursing facilities. In its most recent effort to combat what it views as a lack of progress toward preventing abuse, CMS will now label facilities with recent survey deficiencies related to abuse. Beginning October 23, 2019, a conspicuous icon will be added to Nursing Home Compare for those facilities that meet the following criteria:

• A citation for abuse (F-Tags 600, 602, or 603) where residents were found to be harmed (Scope/Severity of G or higher) on the most recent standard survey or any compliant survey within the last twelve months; or
• Citations for abuse where residents were found to be potentially harmed (Scope/Severity of D or higher) on the most recent standard survey or a complaint survey within the last twelve months, and on the second most recent survey or a complaint survey from twenty-four to twelve months ago. In other words, an incident of abuse that could have potentially led to harm of a resident in each of the past two years.

If a facility meets either of these criteria, the below icon will be added to Nursing Home Compare for that facility:

The icon will be updated on Nursing Home Compare facility pages monthly, along with survey results. CMS states that the purpose of the icon is to provide consumers with up-to-date information when choosing a nursing facility for themselves or their loved ones. CMS has reasoned that the new warning icon is needed to highlight abuse deficiencies despite the availability of published inspection summaries and full reports currently available on Nursing Home Compare. In announcing the move, CMS Administrator Seema Verma acknowledged that while this information is already available, it is not easily accessed on Nursing Home Compare.

Notably, any facility assigned the abuse icon will have their Health Inspection component of the Five Star Quality Rating System capped at two stars. This will cap the overall rating the facility will be able to receive at four stars. For facilities who receive the warning icon, maintaining an overall four-star rating will require a Staffing Rating of four or five stars and a Quality Measure Rating of five stars.

In short, the new change means that abuse-related deficiencies may have a greater effect on overall star ratings than non-abuse related deficiencies of similar scope and severity. The CMS announcement detailing these changes can be found here.

Quality Measures Updates

CMS also announced tweaks to the Quality Measures component of the Five Star Quality Rating System. Effective October 23, 2019 CMS will be removing two quality measures related to pain from the system:

• Percentage of short-stay residents who report moderate to severe pain.
• Percentage of long-stay resident who report moderate to severe pain.

CMS’ stated goal in removing these two quality measures is to reduce any incentive to inappropriately prescribe opioids to residents. Based on the removal of these two measures, the overall point ranges for the Quality Measure star ratings will be adjusted. Thus, facilities with particularly favorable or unfavorable scores in the above quality measures may see changes in their Quality Measures star rating. The CMS announcement describing these updates can be found here.

Conclusion

Both of these updates to the Five Star Quality Rating System will likely result in star rating changes for a number of nursing facilities. Nursing home trade associations, including the American Health Care Association and LeadingAge, have expressed concerns with the new warning label, but absent retraction by CMS, the new updates will take effect on October 23, 2019.

Nursing facilities will need to be mindful of the additional penalties for survey deficiencies related to abuse and ready to challenge any such deficiencies that are insufficiently supported, either through Informal Dispute Resolution, Independent Informal Dispute Resolution, or the appeal process. Nursing facilities with past deficiencies related to abuse should be prepared to answer questions about the new icon in Nursing Home Compare and to communicate with residents and families about efforts to prevent abuse.

Should you or your facility have any questions or concerns about these imminent changes please contact Peter Mellette, Harrison Gibbs, Elizabeth Dahl, or Scott Daisley at Mellette PC.

The Nursing Home Compare Technical Users’ Guide is available here.

This client advisory is for general educational purposes only. It is not intended to provide legal advice specific to any situation you may have. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice.