On June 18, Centers for Medicare and Medicaid Services published new guidance announcing a major change to the way Care Compare will display survey information and the methodology for calculating the health inspection score for Five-Star ratings. In its memo, QSO-25-20-NH, CMS announced that, effective July 2025, Care Compare will display the results of only the two most recent standard surveys. As part of this change, CMS is also making significant updates to the health inspection scoring methodology used for its Five-Star calculations.

Currently, CMS calculates a total weighted health inspection score, with the most recent standard survey weighted most heavily at 50%, the second standard survey weighted at 33.3%, and the third standard survey weighted at 16.7%. Complaint inspections and focused infection control surveys are weighted based on when they occur: the most recent 12 months at 50%, the next 12-month period at one-third, and the following 12 months at one-sixth.

Based on QSO-25-20-NH, not only will CMS drop the third standard survey, but the weighting of the two published standard surveys will change significantly. Starting in July, the most recent standard survey will be weighted at 75%, and the second standard survey will be weighted at only 25%. Complaint and infection control inspections will continue to be weighted based on a three-year period, but the weightings will change.  According to the guidance, the first cycle will now be weighted at 75%, and the remaining two cycles combined at 25%.

In addition to the Five-Star changes, the QSO memo also announced changes related to; (1) the display of performance information for nursing home chains; (2) the incorporation of an updated long-stay antipsychotic measure; and (3) the removal of COVID-19 vaccination measures.

As a result of this updated guidance, skilled nursing facilities may want to consider analyzing their expected Five-Star rating under this new methodology.  As of the date of this alert, CMS has not yet updated its Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide. The guide was last updated in January 2025 and reflects the historical methodology. The updated calculation methodology — and any future updates to the guide — may also impact SNF survey response strategies moving forward. We will continue to watch for updates as this guidance is implemented.