What is the PBJ Policy Manual?

The Centers for Medicare and Medicaid Services (CMS) has long identified staffing as a vital component of a nursing home’s ability to provide quality care.

Section 6106 of the Affordable Care Act requires skilled nursing facilities (SNFs) to submit to CMS their direct care staffing data (including agency and contract staff) - based on payroll and other auditable sources. 

The staffing reporting system is called the Payroll-Based Journal (PBJ) system. The rules for the PBJ system are set forth in the PBJ Policy Manual issued by CMS.  The Payroll-Based Journal Policy Manual also describes in detail the inclusions and exclusions of certain data, and how facilities must fulfill the requirement to report staffing levels to CMS. 

Payroll-Based Journal became the standard data collection method for skilled nursing facilities in 2016, and requires all staffing data for every day of the year. Previous systems of staff reporting were based on recent samples of staffing data, collected during annual survey visits.

Staffing levels and turnover measures are posted on the CMS Care Compare website, and used in the Nursing Home Five Star Quality Rating System to help consumers understand the quality and differences in nursing homes.

How: PBJ-reported staffing data is combined with resident census counts to report Hours Per Resident Day (HPRD) levels of nursing staff in each facility and categorize nursing homes into a Five Star rating system. 

Recent Changes: In 2022, CMS added staff turnover and tenure measures to the staffing Five Star calculation as added ways to for consumers to assess the quality of care delivered.

🔁 2015 - 2016: Defining the rules for Payroll-Based Journal reporting

From April 2015 until the very first time PBJ was reported in November, 2016, CMS issued numerous updates to the PBJ Policy Manuals and accompanying Frequently Asked Questions (FAQ) document.

With the industry adapting to this new requirement, the PBJ Manual triggered many questions and clarifications as skilled nursing facilities operationalized reporting. The repeated updates brought frequent changes and clarifications to the data reporting rules.

You can review the specific changes in each PBJ Policy Manual version in our PBJ Policy Manual archives

🧹 2017 - 2018: Adjustments & refinements of PBJ reporting rules

With the first quarter of PBJ reports delivered to CMS in November, 2016, CMS’ began analyzing the submitted PBJ data.

Early findings led to a rapid series of new PBJ Policy Manuals with many refinements of definitions and meanings. And CMS started to exclude less important data and defined what staffing hours can be reported or not. Usually the stated intent to modify data collection rules stemmed from CMS' goal to create a uniform measurement and analysis tool across all 15,000+ skilled nursing facilities in the U.S.

⚖️ 2019-2025: Long-term steady state of PBJ reporting rules

In late 2018, CMS announced the new Five Star staffing ratings calculated based on payroll-based journal data. With the start of Five Star ratings based on PBJ, the era of major changes to the PBJ Policy Manual ended.

The methods to calculate the staffing Five Star rating are shared in our Five Star User Guide archive.

Two small updates came out in 2022 and 2025 with minor clarifications of the reporting rules to ensure consistent reporting by SNFs.

The PBJ Policy Manual specifies that SNFs must submit this staffing data every calendar quarter:

• Employee ID: a unique, anonymous and unduplicated identifier to evaluate when staff start and stop working in a facility over time. The ID is used to retrospectively calculate rates of turnover.
• Date: The calendar date of when reported hours were worked, calculated from midnight to midnight
• Hours Worked and Paid: The number of hours each staff member both works AND is paid to provide direct care to residents in the nursing home. Unpaid hours are not to be reported.
• Job Title Code: The role performed by staff, in one of 40 standardized PBJ Job Title Codes defined by CMS
• Pay Type Code: How staff are paid – either exempt, non-exempt or contract

Yes! All hours reported via PBJ Reporting can be audited and must be supported by payroll data and vendor invoices. CMS regularly sends auditors to confirm reported PBJ data is accurate and applies penalties to non-compliant SNFs. 

In addition, CMS may trigger a survey or staffing audit when they flag issues such as large changes in reported hours, low weekend staffing, frequent agency nurse usage, and missing 8-hour daily RN coverage.

The most recently published PBJ Policy Manual is version 2.7, which was published in June 2025 and is available on the CMS website

To learn the fundamentals of payroll-based journal reporting, take a course in the PBJ Academy for a practical hands-on understanding of the PBJ manual in real-life.

Or browse our PBJ Manual archive to view prior versions of the PBJ manual and see how it changed over time.