Five Star Quality Rating System State-Level Cut Point Tables Updated April 26, 2023

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

The April 2023 State-Level Cut Point Tables can be found here.

The Centers for Medicare & Medicaid Services (CMS) has enhanced its Nursing Home Compare public reporting site to include a set of quality ratings for each nursing home that participates in Medicare or Medicaid. The ratings take the form of several “star” ratings for each nursing home. The primary goal in launching this rating system is to provide residents and their families with an easy way to understand assessment of nursing home quality, making meaningful distinctions between high and low performing nursing homes.

The rating system features an overall five-star rating based on facility performance for three types of performance measures, each of which has its own associated five-star rating. These domains are: Health Inspections (measures based on outcomes from State health inspection surveys), Staffing (measures based on nursing home staffing levels reported at the time of State health inspection), and Quality Measures (measures based on the CMS Minimum Data Set (MDS)). The Five Star Quality Rating System: Technical Users’ Guide provides detailed information about the content and scoring of each domain, as well as the overall star rating.

This document – Five Star Quality Rating System Technical Users’ Guide: State Level Health Inspection Cut Point Table – provides the data for the state-level cut points for the star ratings included in the health inspection domain. Cut points for the staffing ratings and for the QM ratings have been fixed and do not vary monthly. Data tables giving the cut points for those ratings are included in the Five Star Quality Rating System: Technical Users’ Guide.

CMS’ Five-Star quality ratings for the health inspection domain are based on the relative performance of facilities within a State. This approach helps to control for variation between States. Facility ratings are determined using these criteria:

  • The top 10 percent (lowest 10 percent in terms of health inspection deficiency score) in each State receive a five-star rating.
  • The middle 70 percent of facilities receive a rating of two, three, or four stars, with an equal number (approximately 23.33 percent) in each rating category. 
  • The bottom 20 percent receive a one-star rating.

This distribution is based on CMS experience and input from the Project’s TEP. The cut points are recalibrated each month so that the distribution of star ratings within States remains relatively constant over time in an effort to reduce the likelihood that the rating process affects the health inspection process. In the rare case that a State or territory has fewer than 5 facilities upon which to generate the cut points, the national distribution is used. Cut points for the health inspection ratings by state for the month of April 2023 are shown in Cut Point Table 1 (CP Table 1).