What the Massachusetts quality adjustment is
MassHealth's nursing facility rates are set by the Executive Office of Health and Human Services in 101 CMR 206.00. Since October 1, 2025, section 206.06(2) has adjusted each home's nursing standard rate and operating standard rate, at every PDPM nursing case-mix category, up or down by the sum of three quality measures.
It isn't a pool shared among homes. Each measure adds or takes away a fixed percentage of the home's own standard rate, for the whole rate year. And it can go below zero: the worst score on all three is −7.5%.
The three measures
1. The CMS overall star, as of April 2025
| Overall rating | Rate adjustment |
|---|---|
| 5 stars | +2.0% |
| 4 | +1.0% |
| 3 | 0% |
| 2 | −1.0% |
| 1 | −2.0% |
| 0 | −2.5% |
A Special Focus Facility is treated as 1 star.
2. The DPH Nursing Facility Survey Performance Tool, as of April 1, 2025
| DPH score | Rate adjustment |
|---|---|
| 124 and up | +2.0% |
| 119 to 123 | +1.0% |
| 114 to 118 | 0% |
| 109 to 113 | −2.0% |
| 108 or less | −3.0% |
3. Hospitalizations per 1,000 long-stay resident days, as of June 1, 2025
| CMS adjusted score | Rate adjustment |
|---|---|
| 1.33 or less | +2.0% |
| 1.34 to 1.69 | +1.0% |
| 1.7 | 0% |
| 1.71 to 2.13 | −1.0% |
| 2.14 and up | −2.0% |
That's the long-stay hospitalization measure CMS builds from Medicare claims. All three are attainment only. The version before October 2025 also paid for improving the CMS star and the DPH score; the October 2025 rewrite dropped both and added hospitalizations.
What moves the overall star
The overall rating starts from the health inspection star. Staffing can add or take away a star, and so can the quality measure rating, but only at its edges: 5 QM stars add one, and 1 QM star takes one away. How the QM star is built.
So for a home at 3 overall with 4 QM stars, the next quality measure star is worth one overall star, and in Massachusetts that is a move from 0% to +1.0% on the rate. As of July 2026, 5 QM stars take 1,494 points of 2,300. One 100-point measure moves in steps of 20 points, so one resident can be the difference.
See your building’s overall star and every quality measure against the nation.
The separate staffing cut
| Nursing hours per patient day, each calendar quarter | Rate cut |
|---|---|
| 3.58 or above | None |
| 3.48 to 3.57 | 0.5% |
| 3.38 to 3.47 | 1% |
| 3.28 to 3.37 | 1.5% |
| 3.27 or below | 3% |
When your work shows up
Each measure is a snapshot taken months before the rate year starts. The rate year that began October 1, 2025 used the overall star as of April 2025, the DPH score as of April 1, 2025, and the hospitalization score as of June 1, 2025. EOHHS amends the regulation each rate year and sets new snapshot dates.
The overall star in any April reflects care from well before it, so the quarters that decide a future rate year are the ones happening now.
What SuperQM covers in Massachusetts
SuperQM computes the quality measure part of the CMS star from your own charting, for the quarter you're in: your QM points, the next star line, and the residents between them. That is the part of the overall star you can move fastest, and it decides the edge cases above.
It doesn't cover the rest, and it's worth being plain about that. The DPH survey tool score, the single largest measure, is a state inspection score. Hospitalizations come from claims, so SuperQM shows the figure CMS publishes. The health inspection and staffing stars, and the 3.58-hour test, depend on surveys and payroll: SuperQM shows your published PBJ staffing, about two quarters behind. See how SuperQM works.
