The Government Accountability Office (GAO) has issued a report entitled “Nursing Homes: CMS Needs Milestones and Timelines to Ensure Goals for the Five-Star Quality Rating System are Met." The report, which was mandated by the ACA, examines how CMS developed the Five-Star System, which assigns nursing homes an overall rating and three component ratings (health inspections, staffing, and quality measures) based on the nursing home’s performance on CMS measures. The ratings range from one to five stars, with more stars indicating higher quality. The GAO reports that CMS has several planned efforts intended to improve the Five-Star System, including evaluating the usability of the system, adding nursing home capability information, revising the staffing component, and developing additional quality measures. CMS has not effectively accomplished these improvements, however, because the agency has not set specific goals and deadlines to make the changes, according to the GAO. The GAO recommends that CMS use strategic planning to establish how its planned efforts will help meet the goals of the Five-Star System, and develop milestones and timelines for each of its planned efforts. CMS agreed with these recommendations.