CMS Updates QM Rating Thresholds in Care Compare Refresh

The Centers for Medicare and Medicaid Services (CMS) has updated the Quality Measure (QM) rating thresholds used to assign QM star ratings in its July 2026 Care Compare refresh.

In an overview based on CMS information, here is what did not change in the update.

• The individual Quality Measures.

• How each Quality Measure is calculated.

• The point thresholds assigned to each individual Quality Measure.

  
  

What did change?

• The number of cumulative QM points required to earn each QM star rating.

  
  

As a result, some nursing homes may experience a different QM star rating despite maintaining essentially the same level of measured Quality Measure performance.

In analyzing the update, Steven Littlehale, chief innovation officer, Zimmet Healthcare Services Group, said the July update didn't change how CMS measures quality, it changed the benchmark for recognizing it.

“Some nursing homes may receive a lower Quality Measure star rating despite maintaining essentially the same level of measured performance because CMS raised the threshold needed to earn that rating,” he said. “That's consistent with CMS's long-term goal of ensuring Quality Measure ratings reflect continuous improvement rather than a static benchmark.”

Littlehale said the takeaway for providers is simple: don't manage to today's cut point. Build enough performance margin that when CMS raises the bar, your organization is already above it.

“The challenge is that consumers, referral partners, managed care organizations, and lenders often don't distinguish between a methodology change and a performance change—they simply see one fewer star."

Why Did CMS Act?

This update follows the policy established in CMS Memorandum QSO-19-08-NH (2019).

CMS periodically recalibrates the QM rating thresholds by increasing each threshold by one-half of the average national improvement in QM performance.

For the July 2026 refresh, CMS based the recalibration on national Quality Measure improvement observed between January 2025 and April 2026.

New QM Rating Thresholds

Long-Stay QM Threshold for ★★★★★

• 756 → 767 (+11)

Adjusted Short-Stay QM Threshold for ★★★★★

• 716 → 727 (+11)

All other individual QM point thresholds remain unchanged.

What Does This Mean?

CMS said a nursing home can:

• Maintain essentially the same measured QM performance,

• Perform similarly to the previous reporting period,

• Yet, receive a different QM star rating because the benchmark itself has increased.

  
  

This represents a recalibration of the rating thresholds, not necessarily a decline in quality.

Which Facilities Are Most Likely to Be Affected?

CMS said facilities whose cumulative QM scores fall near one of the revised thresholds are the most likely to experience a change in their QM star rating.

Facilities with substantial margins above or below the thresholds are less likely to be affected. CMS has not published an estimate of how many nursing homes will gain or lose QM stars as a result of the recalibration.

Operator Takeaways

Littlehale said the takeaways for providers include to:

• Monitor cumulative QM scores—not just QM star ratings.

• Know how close they are to each rating threshold.

• Build sufficient performance margin above the minimum required score.

• Review Five-Star Preview Reports before public reporting.

• Be prepared to explain methodology-driven rating changes to stakeholders.

  
  

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.