For nursing home administrators and staff, staying ahead of quality measures is critical—not just for compliance, but to ensure residents receive the best possible care. CMS is updating the 5 Star Rating System to provide more accurate, transparent, and meaningful data. Understanding these changes now will help your team focus improvement efforts, track performance effectively, and highlight your facility’s strengths to residents, families, and regulators.
I. Performance Data for Nursing Home Chains
Starting on July 30, 2025, Nursing Home Care Compare will display performance ratings for nursing home chains. These ratings will be presented in a user-friendly format, giving consumers a clearer picture of the overall quality of care across a chain, rather than just individual facilities.
II. Survey Reporting Health Inspections
The 5-star rating system currently uses three domains: Health Inspections, Staffing, and Quality Measures. Beginning July 2025, the Health Inspections rating will be based on the last two standard surveys instead of the last three, with the most recent survey weighted at 75% and the second most recent at 25%. The three-year cycle will continue to apply for complaint and infection control surveys.
III. Updated Long Stay Antipsychotic Measure
A 2021 OIG report indicated that the MDS may underreport the number of long-stay residents receiving antipsychotics. Starting October 29, 2025, CMS will enhance this measure by including Medicare and Medicaid claims data, along with Medicare Advantage encounter data, to capture medication use not reflected in the MDS 7-day look-back. Exclusion diagnoses such as schizophrenia will also be validated using claims data. As a result, national antipsychotic use is expected to rise from 14.64% to 16.98%, and providers will be categorized into 10 deciles based on performance under the updated measure.
IV. Removing COVID Vaccination Measures
Since 2021, CMS has tracked COVID-19 vaccination rates for residents and staff, displaying this information on Care Compare pages. Effective July 30, 2025, CMS will remove the COVID-19 vaccination section from each nursing home’s main profile to reflect the evolving focus of quality measures.
What This Means for Nursing Home Staff and Administrators
These updates give nursing home teams clearer, more accurate ways to track performance and highlight areas for improvement. By understanding how ratings are calculated and which measures are changing, administrators can better focus quality initiatives, ensure compliance, and showcase the facility’s strengths. Staying informed about these changes helps your staff provide the highest standard of care and positions your facility for continued success under the updated 5 Star Rating System.
