Yesterday (2/28/18), the Centers for Medicare & Medicaid Services (CMS) changed the survey domain methodology of the Five-Star rating system. In the previous methodology, CMS used a center’s most recent three survey cycles in calculating the survey rating. In the updated methodology, CMS will use the most recent two survey cycles in calculating the survey rating. Moving forward, citations from the first cycle will contribute 60% toward a center’s survey rating and will include the most recent standard survey prior to November 28, 2017, as well as any complaint surveys from November 28, 2016, to November 27, 2017. Citations from the second cycle will contribute 40% and will include the previous standard survey, as well as any complaint surveys from November 28, 2015, to November 27, 2016.

The Impact
This change in methodology resulted in 22% of the nation’s centers having a change in their star rating on the Survey Component of Five-Star this month. Of those that experienced a change, 93% had a change of 1 star up or down, while 7% experienced a change of 2 or more stars up or down on the Survey Component of Five-Star. The impact on the OVERALL star ratings is less. AHCA is evaluating this and updates will be added to LTC Trend Tracker in March’s update.

What Else You Need to Know
CMS also started to report data from surveys that occurred after November 27, 2017 (start of new survey process) on the Nursing Home Compare website. While these data will be publicly reported, they will not be used in the determination of survey star ratings until at least 12 months of data have been collected under the new process. Because of the freeze on incorporating data from the new survey process, a center’s survey star rating today is unlikely to change until CMS starts incorporating new survey information. Additional details on how the new survey process will impact Five-Star ratings can be found in this CMS memo.

Contact Information for Questions
CMS will operate a Five-Star helpline available through March 2, and March 26 to March 30, to answer any questions related to the methodology change. The helpline number is 1-800-839-9290 and will be open from 9 am to 5 pm EST. Questions may also be emailed to

Thursday, 3/1/18