Vivage has continued to partner with the nation’s largest association for skilled nursing providers to evaluate the impact of Centers for Medicare and Medicaid (CMS) newly-required PBJ Measures on facility Five-Star Ratings. As part of the Affordable Care Act, PBJ has been enacted by CMS in order to collect mandatory staffing and census information from providers as part of their enhanced data collection and inspection of quality of care delivered by nursing facilities. On April 25, 2018 CMS incorporated PBJ staffing measures into the calculation of Five-Star ratings for skilled facilities. The new PBJ data and changes to the Five-Star staffing methodology resulted in almost half the SNFs in the nation receiving a different staffing star rating in April compared to March. These changes included 1) a switch from reporting hours via the CMS-671 to PBJ, 2) a change in the risk adjustment methodology which now utilizes RUG-66, instead of RUGs-53 and 3) changes to the cut points that determine what level of adjusted staffing is required to attain a certain star rating. CMS now has flagged facilities when the difference in the weekday to weekend staffing hours place a facility in the bottom 20% in their state which may result in a Survey and F‐tag. Vivage has a dedicated team of professionals working with the AHCA research findings and who lead in assuring PBJ compliance education and quality assurance for this CMS initiative in Vivage skilled communities. Vivage also offers PBJ training through its consulting services to skilled nursing facilities.