Reinstated & Replaced QMs

In December 2024, CMS released a Technical User Guide update regarding Five-Star Quality Measures. The user guide includes several updates impacting SNFs, beginning with the Five-Star Ratings in January 2025.

See the updated user guide here: Five Star Technical User Guide

The quality measures that were previously frozen due to the MDS v18 changes will be reinstated and/or replaced. These measures, which have been inactive since the April 2024 refresh, will now factor into the quality measure star ratings. This marks the first time these measures will impact ratings since the specifications were updated to reflect changes in the MDS data. CMS recalculated the scoring cut points to create a more balanced distribution of scores.

1. Two measures have unfrozen, and the points are now respecified:
   • N028 (Long-Stay): Percentage of Residents Whose Need for Help with Activities of Daily Living Has Increased has been respecified to align with the updated MDS.
   • N035 (Long-Stay): Percentage of Residents Whose Ability to Walk Independently (Worsened) has been respecified to reflect the MDS changes.
2. Two Measures have been replaced:
   • S042 (Short-Stay): Percentage of Skilled Nursing Facility (SNF) Residents Who Are At or Above an Expected Ability to Care for Themselves and Move Around at Discharge will replace the previous N037 (Short-Stay): Percentage of Residents Who Made Improvements in Function measure

• • N045 (Long-Stay): Percentage of Residents with Pressure Ulcers will replace the previous N015 (Long-Stay): Percentage of High-Risk Residents with Pressure Ulcers measure.

In addition to these specific quality measure changes, CMS updated the quality measure rating cut points to ensure the same overall distribution.

The thresholds for achieving each star rating have been lowered. For example, a quality measure score of 1300, which previously qualified for three stars, will now earn four stars under the new thresholds.

However, reintroducing the four unfrozen measures adds complexity, potentially making it more challenging for some providers to achieve a score of 1300.

Conclusion

There are a lot of moving parts for providers with these enormous MDS version changes. Simple is committed to quickly and accurately interpreting these changes in our application and we appreciate your partnership as we all get our bearings in this new environment. Please don’t hesitate to reach out with questions or concerns as you explore these changes in our application.

Resources

• 2025 Five-Star Quality Rating System Technical Users’ Guide
• Quality Measures User’s Manual v16
• QRP Measure Calculations User’s Manual v5