The 15 measures
Long-stay: 9 measures, up to 1,150 points
Short-stay: 6 measures, up to 800 points, scaled to 1,150
Bowel and bladder incontinence is published on Care Compare, but it is not one of the 15. It doesn't affect your stars. Every measure, explained.
How a rate becomes points
Each measure has fixed national cut points, published in the technical users' guide. A 150-point measure scores by tenths, from 15 to 150; a 100-point measure scores by fifths, from 20 to 100. Your rate isn't compared to your state or to other buildings this quarter. The line is the same for everyone.
For example, from the July 2026 guide:
| Points | UTI rate | Falls with major injury |
|---|---|---|
| 100 | 0.70% or less | 1.34% or less |
| 80 | up to 1.60% | up to 2.46% |
| 60 | up to 2.72% | up to 3.56% |
| 40 | up to 4.52% | up to 5.14% |
| 20 | above that | above that |
On a unit with 50 long-stay residents, one resident is 2 percentage points. That is often the whole width of a band.
Points to stars
The July 2026 guide raised the cut points for the first time since October 2022:
| Stars | Long-stay | Short-stay | Overall QM |
|---|---|---|---|
| 5 | 767 and up | 727 and up | 1,494 and up |
| 4 | 668 to 766 | 632 to 726 | 1,300 to 1,493 |
| 3 | 590 to 667 | 531 to 631 | 1,121 to 1,299 |
| 2 | 485 to 589 | 443 to 530 | 928 to 1,120 |
| 1 | up to 484 | up to 442 | up to 927 |
Because the lines moved up, a building could lose a star at the July 2026 refresh with no change in care. The new cut points apply from that refresh forward, not back.
How the QM star reaches your overall rating
The overall rating starts from your health inspection star, then:
- Add a star for 5-star staffing, or take one away for 1-star staffing.
- Add a star for a 5-star QM rating, or take one away for a 1-star QM rating.
The result stays between 1 and 5, and a building with a 1-star inspection can only go up by one. So the QM rating moves your overall star at exactly two places: reaching 5 stars, or getting off 1 star. Moving from 3 to 4 QM stars is real progress, and it shows on Care Compare, but it doesn't change the overall rating on its own.
The stars feed money elsewhere. Florida pays 1, 3 or 5 QIP points for a 3, 4 or 5-star overall rating, Illinois pays its quality incentive on the long-stay QM star, and Ohio, Texas, Indiana and New York score the same individual measures.
See your building’s stars and every measure against the nation.
When it changes
CMS refreshes the measures in the last week of January, April, July and October. Each refresh covers four quarters ending two quarters earlier: the July 2026 refresh covers April 2025 through March 2026. A quarter stays in the average for four refreshes, so an improvement shows up a quarter at a time and takes a year to show in full.
What moves the rating
- Know your edge. If you're at 4 stars, the distance to 1,494 is what matters. If you're at 1, it's the distance to 928.
- Measures that can recover. ADL decline and walking decline compare each assessment to one 46 to 165 days earlier, so an improvement can clear the trigger at the next assessment.
- Measures that age out. A UTI is on the assessment for 30 days from the diagnosis; a fall with major injury is caught by a 275-day look-back and clears with time or a corrected code.
- Coding accuracy before the freeze. Corrections after the SNF QRP final submission deadline don't reach Care Compare.
- Know what the MDS can't move. Claims measures are 300 of the 1,150 long-stay points and 450 of the 800 short-stay points.
How SuperQM helps
SuperQM rebuilds your QM rating the way CMS does, shows how far you are from the next star, and names the residents and measures that can get you there this quarter. From CMS's own public files, our engine reproduces the published QM star for all 8,238 rated buildings in the August 2026 refresh. See how SuperQM works.
