With the July 2026 Care Compare refresh, CMS raised the point thresholds for the Five-Star quality measure rating. Your measures are scored exactly as before, but it now takes more total points to earn each star. A building that did nothing different can lose a QM star, and with it a star on its overall rating.
What CMS changed
“Consistent with previous revisions, effective with the July 2026 refresh, CMS is implementing an increase to the Quality Measure (QM) rating thresholds, increasing each rating threshold by one-half of the average improvement in QM scores (QSO 19-08-NH). For the July 2026 refresh, the average improvement was determined from the period of January 2025 – April 2026.”
In plain words: CMS measured how much QM scores rose on average from January 2025 to April 2026 and moved every star boundary up by half of that. The same guide notes that the point thresholds for the individual measures did not change. What moved is the line between stars once your points are added up.
These thresholds had not moved since January 2025. The Technical Users’ Guides for January 2025, January 2026 and April 2026 all print the same table, labeled “as of January 2025”. The guide still says CMS plans to raise the thresholds every six months by half the increase in scores, so expect this to happen again.
The old and new thresholds
These are the lowest scores that earn each star. The top of the range is 1,150 for long- and short-stay and 2,300 overall.
| Star | Long-stay: before → July 2026 | Short-stay (adjusted): before → July 2026 | Overall QM: before → July 2026 |
|---|---|---|---|
| ★★ | 466 → 485 (+19) | 439 → 443 (+4) | 905 → 928 (+23) |
| ★★★ | 566 → 590 (+24) | 526 → 531 (+5) | 1,092 → 1,121 (+29) |
| ★★★★ | 641 → 668 (+27) | 626 → 632 (+6) | 1,267 → 1,300 (+33) |
| ★★★★★ | 736 → 767 (+31) | 720 → 727 (+7) | 1,456 → 1,494 (+38) |
Anything under the two-star line is one star. The scores can run from 155 to 1,150 for long-stay, 144 to 1,150 for short-stay after CMS’s 1,150/800 adjustment, and 299 to 2,300 overall. The September 2026 guide prints the same table, so these are still the thresholds in use.
Two things stand out. The long-stay lines moved about four to five times as far as the short-stay lines, so the pressure is on long-stay scores. And the higher the star, the bigger the jump: 38 more points for five stars overall, against 23 for two.
What it means for your building
An example. A building’s overall QM score is 1,470 in April and still 1,470 in July. In April that was five QM stars, since the line was 1,456. In July the line is 1,494, so it is four. On the overall rating, a five-star QM rating adds a star and a four-star one adds nothing, so unless the overall rating was already capped, it drops a star with no change in care.
Most individual measures move in steps of 20 points (the 100-point measures) or 15 points (the 150-point ones). One measure that improves by a single step is often enough to close a gap of 20 to 40 points, and one that slips a step can open one. If your score was within about 40 points above a line in April, check where it landed in July.
See your building’s QM score and its distance to the next star, free.
The other Five-Star changes, 2025–2026
| Refresh | Change |
|---|---|
| January 2025 | Four quality measures that had been frozen since April 2024 came back, rebuilt for the new MDS: the discharge function score replaced the short-stay functional improvement measure, the long-stay ADL and walking measures were re-specified, and the long-stay pressure ulcer measure replaced the high-risk version. Their cut points were recalculated, and the QM rating thresholds were set to keep the same overall distribution. |
| July 2025 | The health inspection rating now uses the two most recent standard surveys instead of three, with complaint and infection control surveys still counted over three years. The four claims-based measures gained Section GG function risk adjusters, and their cut points were revised to keep the same distribution. |
| January 2026 | The long-stay antipsychotic measure was replaced by a re-specified version that adds Medicare and Medicaid claims and Medicare Advantage encounter data. Its cut points were set to ten equal deciles. See QM User’s Manual v18.0: what changed. |
| April 2026 | A fix to exclude all residents with a history of schizophrenia from that measure, as specified. CMS says it did not significantly change scores, but it reset the measure’s cut points using 2024Q4–2025Q3 data. |
| July 2026 | The QM rating thresholds above. |
| September 2026 | A trophy icon for high-performing nursing homes (below). |
CMS’s memo on the July 2025 change says the most recent survey cycle, together with complaint and infection control surveys from the past 12 months, carries 75% of the weight, and the second cycle and the older complaint and infection control surveys carry 25%.
September 2026: the trophy icon
“Effective with the September 2026 refresh, nursing homes that perform highly, in addition to the traditional 5-star rating, will have a trophy icon.”
The icon marks the nursing homes that qualify for CMS’s new risk-based survey, a shorter standard survey with a smaller team, which states began using on September 8, 2026 (memo QSO-26-14-NH). CMS said the list and the icon would be public on Care Compare from September 30, 2026, and estimated that about 12% of nursing homes nationwide qualify. Among the criteria, a building must not have:
- an overall rating below five stars, or a staffing rating below three stars;
- any citation for actual harm, immediate jeopardy or substandard quality of care in the last survey cycle (the last standard survey and any complaint investigations in the last year);
- a health inspection score worse than the state’s median;
- a failed PBJ staffing audit or a failed MDS audit;
- two or more residents aged 65 or older coded with schizophrenia after being admitted without that diagnosis.
The full list also includes more than 18 months without a standard survey, a staffing waiver in effect, a change of ownership since the last standard survey, and being a Special Focus Facility candidate. The icon comes off when the building no longer qualifies.
The QM rating feeds the overall rating, and the trophy starts with a five-star overall rating, so the July thresholds reach this too. SuperQM scores your current quarter against the July 2026 thresholds, so you can see how close you are to each line before CMS publishes it.
Sources
- Five-Star Quality Rating System Technical Users’ Guide, July 2026 (Table 5 and revision notes)
- Five-Star Technical Users’ Guide, September 2026
- Five-Star Technical Users’ Guides, January 2025, January 2026 and April 2026 (archive)
- CMS memo QSO-26-14-NH, Nursing Home Risk-Based Survey National Implementation (July 16, 2026)
- CMS memo QSO-25-20-NH REVISED, Updates to Nursing Home Care Compare (revised September 10, 2025)
