Another Update to the Five Star Technical Users Guide (3/09) 
The Five-Star Quality Rating System Technical Users' Guide has been updated, effective 3/25/09.

• Beginning with this (March 2009) version, the Technical Users' Guide consists of two documents:  (1) The Five-Star Quality Rating System Technical Users' Guide and (2) the Five Star Quality Rating System State-Level Cut Point Tables.
• This first edition of the state-Level Cut Point Tables document contains a brief description of each five-star domain for which state-level cut points are used [pages 1, 2]; updated State-level cut point tables for health surveys [page 2 - 4]; ADL QM, Late Loss ADL Worsening  [pages 5, 6]; ADL QM Worsening Locomotion [pages 7,8].
• Cut points for the staffing ratings and for the non-ADL QM ratings have been fixed and do not vary monthly.
• Removal of Table A3 – information is contained in Tables 3 and 4 in the text [pages 9, 10].

In addition, beginning with this version, CMS has posted a data file that contains the reported, expected, and adjusted staffing time values used in the staffing star calculations.

• It contains one record for every nursing home currently shown on Nursing Home Compare.
• Each of these records contains the CMS Certification Number (CCN) for the provider, the name of the provider, the city and state in which the provider is located, and 15 staffing values, calculated as hours per resident per day.
• The 15 staffing variables are divided into 3 groups of 5 values each.
• The first group includes values derived from those reported by the nursing home on the CMS 671 and 672 reporting forms.
• The second group of values represents CMS’s calculation of expected staffing time based on the RUGS 53 staff time values for residents in the nursing home at the time of the survey.
• The third group of values represents the adjusted time, which is calculated by this formula:  Hours Adjusted = (Hours Reported/Hours Expected) * Hours National Average

CMS will update this spreadsheet on a monthly basis, coinciding with website updates.
Design for Nursing Home Compare Five-Star Quality Rating System:
Technical Users’ Guide
Updates Included in the March 2009 version
The March 2009 version of the Users’ Guide includes a number of updates:

• State-level cut point tables have been moved into a new document: Five-Star Quality Rating System: State-Level Cut Point Tables (see CMS webpage: http://www.cms.hhs.gov/CertificationandComplianc/13_FSQRS.asp) (page 9)
• Removal of Table A3 – information is contained in Tables 3 and 4 in the text (pages 9,10)
• Added link to downloadable file containing facility-level “expected” and “reported” staffing times that are used in the staffing star calculations (page 9)

Technical Users’ Guide
State-Level Cut Point Tables
Updates Included in the March 2009 version
The March 2009 version is the first edition of the State-Level Cut-Point Tables document. It contains:
• Brief description of each Five-Star domain for which State-level cut points are used (pages 1,2)
• Updated State-level cut point tables for:
o Health Inspection Scores (pages 3,4)
o ADL QM Late Loss ADL Worsening (pages 5,6)
o ADL QM Worsening Locomotion (pages 7,8)