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The Reality of the CMS Five-Star Program – Frozen or Not?

By Jane Belt, MS, RN, QCP, RAC-MT, RAC-MTA - June 10, 2020

The COVID-19 pandemic has inspired a flurry of news, updates, and clarifications as regulators and facilities alike attempt to respond to an evolving situation. Keeping straight what is happening in the world of long-term care has become even more of a challenge. One area nurse leaders and nurse assessment coordinators should be paying attention to concerns the Centers for Medicare & Medicaid Services (CMS) and what is happening to the Five-Star ratings for long-term care facilities.

Before we break it down domain-by-domain, note that the Five-Star Quality Rating System is not totally frozen! For the present, only the health inspection domain rating will not change.

Some of the numerous recent notices affecting the Five-Star program domains are:

March 4, 2020 – Ref: QSO-20-12-All. Suspension of Survey Activities. CMS stated its commitment to taking critical steps to ensure America’s healthcare facilities were prepared to respond to the threat of the 2019 Novel Coronavirus (COVID-19). The memorandum announced that CMS was suspending non-emergency inspections. It also contained protocols for conducting the surveys and a copy of the Critical Element Pathway (CEP) for Infection Prevention Control & Immunization.


March 23, 2020 – Ref: QSO-20-20-All. Prioritization of Survey Activities. The targeted plan for surveys was implemented to allow CMS to focus inspections on the most urgent situations. The 28-page document contained the COVID-19 Focused Survey for Nursing Homes tool (3/20/20) and a summary of the protocols for off-site activity, onsite survey activity, and facility self-assessment. Over a three-week timeframe, the types of inspections that were prioritized and conducted were: