The CMS Nursing Home Care Compare Five-Star Quality Rating System — the public-facing star rating families and referral sources use to evaluate nursing homes — went through two significant technical updates in 2026, and both make it harder to maintain a given star rating without genuinely improving performance.
The July 2026 Quality Measure threshold increase
With the July 2026 refresh, CMS raised each Quality Measure (QM) rating threshold by one-half of the average improvement in QM scores, using data from January 2025 through April 2026 and the approach in QSO 19-08-NH. The new values are in Table 5 of the Five-Star Technical User's Guide. According to AHCA/NCAL, the point thresholds for individual QMs did not change; only the rating thresholds moved. A facility holding identical performance can therefore see its QM star rating fall.
This matters because QM rating feeds the Overall rating. A drop in QM stars can change the overall rating:
| QM rating change | Effect on the overall rating |
|---|---|
| Falls from 5 QM stars to 4 | Loses eligibility for a one-star upward adjustment |
| Falls from 2 QM stars to 1 | May receive a one-star reduction |
Facilities earn points across nine long-stay and six short-stay QMs.
What this means for facility leadership
- A stable QM point total is not the same as a stable star rating. Build this distinction into how you communicate ratings internally — a rating change without a documented performance change is often a threshold shift, not a facility problem, but it still needs to be understood and explained to ownership, referral partners, and families.
- Monitor your points, not just your stars. Tracking the underlying QM point total over time gives leadership a clearer, more stable signal than watching the star rating alone, since the star rating can move due to CMS methodology changes independent of your facility's actual performance.
- QAPI processes matter more, not less, in a moving-threshold environment. Since the bar keeps rising, sustained improvement — not just holding steady — is what's actually required to maintain your current rating over time.
- Check the Technical User's Guide Table 5 for your new star cut-points and compare them to your current point total.
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