Resources
This document provides the data for the state-level cut points for the star ratings included in the health inspection domain. Cut points for the staffing ratings and for the QM ratings have been fixed and do not vary monthly. Data tables giving the cut points for those ratings are included in the Five Star Quality Rating System: Technical Users’ Guide.
Beneficiary and Family Centered Care (BFCC)-QIOs
Kepro Service Areas
Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIO) help Medicare beneficiaries with their concerns about the quality of care they receive from a Medicare provider. The Quality Improvement Organization (QIO) is a group of health quality experts, providers, and consumers organized to improve the quality of care delivered to people with Medicare.
The BFCC-QIOs (Kepro) review complaints and quality of care and help to improve the effectiveness, efficiency, economy and quality of services provided to people with Medicare. BFCC-QIOs provide services to help with complaints and quality of care reviews.
You can also contact your BFCC-QIO for help in filing an appeal in a hospital or non-hospital setting if you think your coverage is ending too soon (for example, if your hospital says that you must be discharged and you disagree). You have the right to a fast appeal if you think your Medicare-covered services are ending too soon.
Contact your BFCC-QIO to ask questions or report concerns about the quality of care you received for a Medicare-covered service (and/or if you are not satisfied with the way your provider has responded to your concern). For more information or help, contact your BFCC-QIO. Also, if you have any issues or further concerns after filing a quality of care complaint or a discharge appeal with your designated QIO, please contact the CMS QIO Concerns Mailbox for assistance.
CMS Released a Correction to the PDPM Files for Oct. 1, 2024
The Centers for Medicare & Medicaid Services (CMS) announced corrections to the Patient-Driven Payment Model (PDPM) mapping files for I0020B, the primary diagnosis representing the reason for the skilled nursing home stay, which is also used to determine a resident’s clinical category assignment under PDPM. CMS released an update to iQIES on April 16, 2024, to implement the corrected codes.
The updated PDPM Mapping zip files have been posted on the CMS-1779-F2 correction notice page. These files have not yet been posted to the PDPM resources page at this time.
Note: If an assessment HIPPS code was impacted by these updates with an ARD of Oct. 1, 2023 or later, a modification and claim adjustment may be necessary.
Notice: 5 Star Preview Reports - April 2024
The Five Star Preview Reports will be available on or around April 17, 2024. Provider Preview Reports have moved to iQIES as of August 2023. Please follow the steps below to locate the Provider Preview Report in iQIES:
1) Log into iQIES at https://iqies.cms.gov/ using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) user ID and password.
2) Select the My Reports option from the Reports menu.
3) From the My Reports page, locate the Provider Preview Reports folder.
Nursing Home Care Compare will update with the March Five Star data on or around April 24, 2024.
Contact the iQIES Service Center via email (iQIES@CMS.HHS.GOV) or by phone (800-339-9313) if assistance is required to log into iQIES or to locate the Provider Preview Report.
Proposed Payment Rules
FY 2025 Skilled Nursing Facility Prospective Payment System Proposed Rule
Learn about the FY 2025 Skilled Nursing Facility Prospective Payment System proposed rule. See the rule and related files for more information.