CMS Updates Five-Star QM Thresholds for July 2026

CMS has updated the Quality Measure (QM) rating thresholds used in the Nursing Home Care Compare Five-Star Rating System beginning with the July 2026 refresh. 

While the scoring methodology and point values for individual Quality Measures are not changing, facilities will need more total QM points to earn or maintain the same QM star rating. CMS periodically adjusts these thresholds to reflect improvements in national nursing home performance. 

For this update, CMS used national performance improvements observed between January 2025 and April 2026 and increased each rating threshold by one-half of the average improvement in QM scores. 

New QM Rating Thresholds

The total QM score ranges from 299 to 2,300 points. Beginning in July 2026, the updated QM rating thresholds are: 

To earn a QM rating in July 2026, facilities will need at least: 

• 928 points for 2 Stars
• 1,121 points for 3 Stars
• 1,300 points for 4 Stars 
• 1,494 points for 5 Stars 

The largest increases are at the 4-Star and 5-Star levels, which now require an additional 38 points. 

This type of adjustment helps CMS maintain meaningful differentiation among nursing homes as national QM performance improves. 

What This Means 

A facility can maintain the same QM point total and still receive a lower QM star rating if it falls below the new threshold. 

Example: A facility with 1,480 QM points previously qualified for a 5-Star QM rating. Under the July 2026 thresholds, 1,494 points are required for 5 Stars, so the same facility would now receive a 4-Star QM rating despite no change in performance. 

Because QM is one of the components used in CMS’ Overall Five-Star methodology, a change in QM rating can also affect a facility’s Overall Star Rating. In some situations, a facility predicted to be a 5-Star overall provider could decrease to 4 Stars solely because its QM rating moved from 5 Stars to 4 Stars under the new thresholds. 

The actual impact on a facility’s overall rating will still depend on its health inspection, staffing and QM domain results, along with the other rules CMS used to calculate the overall Five-Star rating. 

What Isn’t Changing 

• Individual Quality Measure point ranges 
• QM scoring methodology 
• How CMS assigns points for each measure 

The only change is the number of total QM points required to achieve each QM star rating. 

In other words, a lower star rating may reflect a higher CMS threshold rather than a decline in the facility’s underlying QM performance. 

What Providers Should Do 

Before the July refresh, facilities should: 

• Review current QM scores against the new thresholds 
• Identify proximity to rating cutoffs 
• Focus on measures contributing the most points 
• Evaluate potential impact on Overall Five-Star ratings 
• Communicate anticipated changes to leadership and quality teams 

Facilities near a cutoff should remember that a star rating decline does not necessarily indicate worsening performance. In some cases, the change reflects higher national benchmarks rather than a drop in quality. 

Reviewing recent performance trends alongside the current star rating can also help teams better understand whether a change is driven by their own results or by the updated thresholds. 

How Simple Is Helping 

Simple has updated its analytics software to reflect the July 2026 QM thresholds. These updates will be reflected soon in the data allowing clients to: 

• Monitor performance using the updated CMS methodology 
• Identify potential QM rating changes before Care Compare updates 
• Assess potential Five-Star impacts 
• Prioritize improvement opportunities 
• Track progress toward higher QM ratings using current CMS thresholds 

By understanding where they stand relative to the new benchmarks, facilities can better prepare for the July 2026 Care Compare refresh and proactively manage potential rating changes.