The Affordable Care Act requires CMS to collect electronic staffing data from nursing centers. The Act requires this data to be auditable and verifiable. The information is intended to collect direct care staff (employed and contracted), employee turnover and tenure, and must include census data and case mix. CMS developed the Payroll-Based Journal (PBJ) to collect this data. Details on the collection methodology and other policies related to staffing data submission can be found in the latest PBJ Policy Manual and FAQs can be found here.
In April 2018, CMS started to use PBJ data to determine each facility’s staffing rating used in the Nursing Home Five-Star Quality Rating System.
In April 2019, CMS announced changes to the staffing component of Five-Star. CMS will be adjusting the thresholds for overall staffing ratings, which will provide a greater emphasis on RN staffing. Additionally, CMS will give a one-star staffing rating to those facilities that report four or more days without an RN in a quarter. More information on these changes can be found in the Five-Star Technical User Guide.