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Nursing Home Compare Updates and PPS


Earlier this month, the Centers for Medicare & Medicaid Services (CMS) announced updates coming in April to the Nursing Home Compare and the Five-Star Quality Rating Systems. The April changes are part of a broad range of updates that have been under development for the last several years. These systems were intended to help consumers, their families, and caregivers compare nursing homes when making decisions on placement for themselves or loved ones. These systems are also vital to the quality rate component under the new Prospective Payment System (PPS) for Medicaid reimbursement so any changes to these two systems have a broad reaching impact on Florida SNF providers.

Nursing Home Compare drives the Five-Star Quality Rating System, which is a quality component under Medicaid PPS reimbursement separate from the process and outcome measures derived from the Nursing Home Compare. Overall, these two systems combined can account for up to 29 total quality points available under PPS. At the current rate per point of $1.23, they account for up to $35.67 per Medicaid resident day. So, any changes to these systems are extremely important to understand.

For specifics on the April 2019 changes to Nursing Home Compare, read the recent post from Deborah Franklin of FHCA.

Lorne Simmons is with MSL CPAs & Advisors, Florida Health Care Association's CPA Consultant. Lorne is located in MSL’s Tallahassee/North Florida office.