Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Final Rule

On July 7, 2022, CMS released the changes to calculate the five-star staffing rating in the updated Nursing Home Five-Star Quality Rating System Technical Users’ Guide. The changes include the addition of weekend staffing and staff turnover into the facility score as of the July 27, 2022 Nursing Home Care Compare refresh. CMS also is no longer allowing facilities with four-star staffing ratings to get an additional star for their overall star rating.

The star rating will now be calculated based on six measures:

  • RN adjusted hours per patient day (PPD)
  • Total nurse hours PPD
  • Total nurse hours PPD on weekends
  • RN turnover
  • Total nurse turnover
  • Number of administrator departures

The star staff calculation will be based on a point system. Each measure is assigned points based on predetermined cut points with the maximum possible score of 380.

  • RN adjusted hours PPD – 100 points
  • Total adjusted nurse hours PPD – 100 points
  • Total nurse hours PPD on weekends – 50 points
  • RN turnover – 50 points
  • Total nurse turnover – 50 points
  • Number of administrator departures – 30 points

CMS will exclude any measure that cannot be calculated due to inaccurate or missing data necessary to calculate the measure. The calculation of total points per facility will be rescaled based on the points assigned to the excluded measure.

The staffing star rating will be assigned based on total points achieved accordingly:

Point Ranges for the Staffing Rating (maximum possible score = 380 points)

1 Star 2 Stars 3 Stars 4 Stars 5 Stars
< 155 155-204 205 - 254 255 - 319 320 - 380

Note: These cut points are applied after any necessary rescaling of the staffing score to have a maximum possible of 380 points

The updated Technical Users’ Guide can be found on the CMS site. If you have any questions or need assistance, please reach out to a professional at FORVIS or submit the Contact Us form below.

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