On December 5, 2008, the Centers for Medicare & Medicaid Services (CMS) issued a State Survey Agency Directors letter advising the state survey agencies that CMS’s new Five Star Quality Rating program for nursing homes would “go live” on December 18, 2008. On December 16, 2008, providers were able to see a “preview” of their current rating via the electronic connection on which providers submit their MDS data electronically. To see the preview two days before the program went live, providers had to log on to their MDS state server, and, according to the CMS, providers were to check their online mailboxes there.

The new rating system provides an Overall Rating for each facility and rates the facility on three types of measures: 1) performance on surveys, 2) staffing levels, and 3) quality-measures scores. The ratings that are displayed on CMS’s Nursing Home Compare website began December 18, 2008. According to the CMS letter to state agency directors, a rating of 5 stars indicates a “much above average quality” rating and a rating of 1 star indicates “quality much below average.” CMS provided no discussion of what ratings between 1 and 5 should mean, either to providers or to the public.

Finally, the state agency letter indicated that CMS would host a national press conference call about the new rating system but provided no details.