CMS Five-Star quality measure rating system

How the public Care Compare star rating is actually calculated — and why your rating can drop with zero change in your facility's performance.

CMS Nursing Home Care Compare — Five-Star Technical Users' Guide · Updated Nov 5, 2026

This page is CMI's own briefing on the topic, written by CMI. It is not the text of the regulation. Read the regulation itself in the Regulatory hub or at the official source.

What it is: A public 1-5 star rating combining Health Inspections, Staffing and Quality Measures (QM), used by families, referral sources and payers.

July 2026 refresh: CMS raised each QM rating threshold by one-half of the average improvement in QM scores (data January 2025 to April 2026). Per AHCA/NCAL, individual QM point thresholds did not change. Exact new thresholds are in Table 5 of the Technical User's Guide.

Why it can move without a performance change: a facility with the same points can drop a QM star. Falling from 5 to 4 QM stars removes eligibility for a one-star upward adjustment to the overall rating; falling from 2 to 1 may reduce the overall rating by a star.

What to track: your raw QM points over time, separately from stars.

Last verified against agency sources on October 30, 2026.