Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (1/21)

By CMS - January 18, 2021

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. This manual provides in-depth descriptions of the ratings and the methods used to calculate them. 

On December 1, 2020 the Nursing Home Compare website was retired. It has been replaced by the new Care Compare website. Care Compare can be accessed at: ( The Provider Data Catalog (PDC) located at allows users to search and download the publicly reported data. While this Technical Users’ Guide has been revised to refer to Care Compare, there may be previously published materials or documents that refer to Nursing Home Compare and all prior references to Nursing Home Compare will now apply to Care Compare.


January 2021 Revisions


Health Inspection Rating Changes:

Beginning with the January 2021 refresh, CMS resumed calculating the health inspection rating domain and began to use results from surveys that occurred after March 3, 2020. Additionally, focused infection control surveys are included in the rating calculation, with citations from these surveys counting towards the total weighted health inspection score (similar to how complaint survey citations are counted).

These changes resulted in updates to the Special Focus Facility (SFF) program, including updates to SFF candidates, and facilities’ status for receiving an icon for noncompliance related to abuse. Specifically, updates to the health inspection data due to the incorporation of surveys occurring after March 3, 2020 and the updating of the complaint periods means that the abuse icon will be removed for facilities that no longer meet the abuse icon criteria based on more recent survey findings. Once facilities no longer meet criteria for the abuse icon, their health inspection rating will no longer be capped at two stars. More information on the abuse icon is found in the Health Inspection section of this document.

Staffing Rating Changes:

Beginning with the January 2021 refresh, facilities that did not report staffing for the November 14, 2020 deadline or that reported four or more days in the quarter with no registered nurse will have their staffing ratings suppressed. Their staffing ratings will show “Not Available” with the January, February, and March refreshes. Starting with the April 2021 refresh of Care Compare, when staffing data submitted by the February 14, 2021 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for October – December 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star.


Quality Measure Rating Changes:

Quarterly updates of most of the quality measures (QMs) posted on Care Compare and used in the FiveStar Quality Rating System resumed with the January 2021 refresh. For the January 2021 update, CMS used data for July 2019- June 2020 for all of the measures that were updated. The two QMs that are part of the Skilled Nursing Facility Quality Reporting Program (Percentage of SNF residents with pressure ulcers/pressure injuries that are new or worsened and Rate of successful return to home and community from a SNF) will not be updated in January 2021.

January 2020 addition: Technical specifications for claims-based measures