Five-Star Technical User's Guide UPDATED (10/19)

By CMS - October 08, 2019

CMS created the Five-Star (5-Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated in October 2019.


October 2019 Revisions


In October 2019, several changes will be made to the Nursing Home Compare website and the FiveStar Quality Rating System. These changes will affect the health inspection and quality measure domains. This section provides details on these changes.

Ratings changes for facilities that receive the abuse icon: To make it easier for consumers to identify facilities with instances of non-compliance related to abuse, starting in October 2019, CMS is adding an icon to highlight facilities that meet either of the following criteria: 

1) Harm-level abuse citation in the most recent survey cycle: Facilities cited for abuse where residents were found to be harmed (Scope/Severity of G or higher) on the most recent standard survey or on a complaint survey within the past 12 months. 

2) Repeat abuse citations: Facilities cited for abuse where residents were found to be potentially harmed (Scope/Severity of D or higher) on the most recent standard survey or on a complaint survey within the past 12 months and on the previous (i.e., second most recent) standard survey or on a complaint survey in the prior 12 months (i.e., from 12 to 24 months ago). 

Nursing homes that receive the abuse icon will have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that has received the abuse icon can have is four stars.

Removal of quality measures related to pain: CMS will be removing two quality measures (QMs) from the Nursing Home Compare website and the Five-Star Quality Rating System in October 2019. These measures are: 

• Percentage of short-stay residents who report moderate to severe pain. 

• Percentage of long-stay residents who report moderate to severe pain. 

As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings will change starting in October. These changes will be made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. The new cut-points are shown in the table in the introduction. Note that this table will replace Table 6 in the Technical Users’ Guide (TUG) starting after these changes are implemented in October 2019.