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Five Star Updates, Nursing Home Staff Counts, and FAQs

Posted Apr 25, 20204 min Read

Regulatory & Clinical

On April 24, 2020, the Centers for Medicare & Medicaid Services (CMS) released a memo (QSO-20-28-NH) with updates on Nursing Home Compare (NHC), Five Star, public staffing information, and a list of frequently asked questions (FAQs).

Inspection Domain of Five Star Quality Rating System Will NOT be Updated Due to Prioritization of Surveys

CMS will temporarily hold constant the inspection domain of Five Star to prevent an unequal impact on the rating for those facilities who receive a survey during this time. This freeze will begin with the scheduled Nursing Home Compare update on April 29, 2020.

CMS will post the results of any health inspections conducted on or after March 4, 2020, on the landing page of Nursing Home Compare, but they will not be used to calculate a center’s Five Star inspection rating.

The Quality Measure and Staffing domains of Five Star will be updated on April 29 as they are not impacted by the CMS blanket waivers because they rely on data from before March 1, 2020.

Release of Certain Staffing Information

CMS will use Payroll-Based Journal staffing data to publicly report the average number of staff onsite at each nursing home each day (both nursing staff and total staff) and will also post aggregated data at a state and national level. The publicly posted information will include all staff listed in section 2.3, Table 1 of the PBJ Policy Manual.

This information will be based on data submitted for the fourth quarter of 2019. CMS states this information can be used to help local, state, and federal agencies’ plan for how much personal protective equipment (PPE), testing and other resources providers may need. Providers can also use this information along with the CDC PPE burn rate calculator.


The memo includes a FAQ document that addresses CMS guidance in the areas of visitation, surveys, waivers, and more. The FAQs provide information on topics including:

  • Individuals entering and leaving the nursing center, including visits by health care personnel, visitation for compassionate care situations, and residents who want to leave the facility against medical advice;
  • Surveys and infection control self-assessment, including the ongoing suspension of standard surveys and the recommended use of the infection control focused survey protocol for self-assessment on infection control practices and preparedness;
  • Waivers of Federal requirements including those related to in-facility and inter-facility cohorting; and,
  • Additional information on resident cohorting, separation and admission.

CMS reminds providers that a negative test for COVID-19 is not a prerequisite for discharging a resident to a nursing home from the hospital; however, consistent with current guidance, admissions decisions should be made based on the resident’s clinical status and the ability of the accepting facility to meet their care needs and infection control requirements. Providers who can’t meet the needs of the residents due to PPE, staffing or other issues should not accept the person.

CMS is allowing civil money penalty (CMP) funds to be used for purchasing devices such as tablets or web-cams as well as accessories, with a maximum of $3,000 allowed per facility to help with communications between residents and their families or friends. To apply to receive CMP funds for this purpose, contact your state agency’s CMP contact.


For questions related to the Nursing Home Compare website and the Five Star Quality Rating System, please email

For questions related to the FAQs, please email

About the Author


The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities.