What the Michigan QMI is
The Nursing Facility Quality Measure Initiative is a supplemental Medicaid payment run by the Michigan Department of Health and Human Services. It started on October 1, 2017, under state plan amendment 17-0009, and its rules sit in the Medicaid Provider Manual's nursing facility cost reporting and reimbursement appendix, section 10.7.D.
It is paid for by the nursing facility quality assurance assessment, the provider tax, which carries a separate QMI rate. MDHHS set that rate again for October 2025, and in May 2026 it told buildings how the resident survey factor works for the rate year starting October 1, 2026.
What it pays on
One thing: the CMS quality measure star on Care Compare. Not the overall rating, not inspections, not staffing. MDHHS averages that star from July of the prior year through June, so the rate year starting October 1, 2026 rests on the stars shown from July 2025 through June 2026.
MDHHS sets a per-bed amount for each rating from the money available that year, larger for a higher star. It hasn't published a current table, so we don't quote one.
Then two adjustments:
| Factor | What you get |
|---|---|
| Medicaid use above 63% | 100% of the per-bed amount |
| Medicaid use 50% to 63% | 75% |
| Medicaid use under 50% | Your Medicaid share (35% use pays 35%) |
| Resident survey data submitted | 100% |
| No resident survey data | 85% |
The result is multiplied by your licensed nursing facility beds, not Medicaid days. Beds count whatever their certification, Medicare-only and licensed-only included. Medicaid use comes from your prior year-end cost report.
How it’s paid, and who isn’t
MDHHS calculates the year's payment at the start of the state fiscal year, October 1, and pays it as a monthly gross adjustment:
Per-bed amount × Medicaid use scale × survey factor × licensed beds ÷ eligible months.
A building whose average star is below 2.5 has to file an action plan before it is paid. The plan picks four quality measures where the building is worse than the Michigan average and says how the QMI money will improve them. Miss the due date by more than 30 days and there is no QMI payment for the rest of the fiscal year.
Special Focus Facilities aren't paid until they graduate, and then only for the months left. To be paid at all, a building needs a 1- to 5-star quality measure rating, Medicaid certification, and at least one Medicaid day in the year. After a change of owner, the new owner is paid on the old owner's star, Medicaid use, beds and survey.
The resident survey
The survey factor is worth 15% of the payment. For the rate year from October 1, 2026, MDHHS wanted resident satisfaction data from a survey run no earlier than June 27, 2025, sent by August 14, 2026. Any method counts, but it has to be a resident survey, not a family or staff one, and data used for a prior year's QMI isn't accepted.
What the quality measure star is made of
CMS adds up points on 15 measures, nine long-stay and six short-stay, for up to 2,300, and stars the total on national cut points:
| QM star | Points (as of July 2026) |
|---|---|
| 5 | 1,494 and up |
| 4 | 1,300 to 1,493 |
| 3 | 1,121 to 1,299 |
| 2 | 928 to 1,120 |
| 1 | up to 927 |
The long-stay MDS measures are need for help with daily activities, walking, pressure ulcers, catheters, UTIs, falls with major injury and antipsychotics. The short-stay MDS measures are the discharge function score, new or worsened pressure ulcers and new antipsychotics. Hospitalizations, ED visits and return to the community come from Medicare claims. How each measure is pointed.
CMS plans to raise these cut points every six months, so a building standing still can lose a star. What changed in July 2026.
See your building’s quality measure star and every measure behind it.
When your work shows up
Care Compare refreshes the measures four times a year, and each refresh covers four quarters ending two quarters earlier. Care in the quarter ending September 2026 first shows up in the January 2027 refresh and stays for four refreshes.
Michigan then averages the stars from July to June and pays from the following October. So the January and April 2027 stars set the rate year starting October 2027, and the July and October 2027 stars the year after. By our count, work done now pays from about a year out, for about two years.
How SuperQM helps Michigan buildings
SuperQM scores the MDS measures from your own charting, for the quarter you're in, and shows your points against the next quality measure star. When a resident is about to tip a measure into a lower band, or a code doesn't match the chart, the right person hears about it that day.
By our count, the MDS measures are about three-fifths of the 2,300 points. The claims measures come from Medicare, so SuperQM shows CMS's published figure for those. Long-stay antipsychotic use has blended claims with the MDS since January 2026. SuperQM doesn't run resident surveys, and Medicaid use and bed counts come from your cost report and license. See how SuperQM works.
