What the rating measures
The overall star rating is a composite of three component ratings. Health inspections, drawn from state survey results over the most recent three cycles, carry the largest weight in the methodology. Staffing, based on payroll-based journal data including registered nurse hours and total nursing hours per resident day. Quality measures, computed from clinical indicators reported by the facility and from claims data. CMS publishes the full technical methodology and updates it periodically.
Who runs the rating
The Centers for Medicare and Medicaid Services, a federal agency within the US Department of Health and Human Services, runs the program. The data sources include state inspection reports, the federal Payroll-Based Journal staffing system, and Minimum Data Set assessments submitted by facilities. State survey agencies conduct the on-site inspections under contract with CMS.
How families use the rating
Care Compare displays the overall star rating, the three component scores, and detailed health inspection findings for every certified facility. Families typically use the rating as a screening tool, narrowing a list of nearby facilities to a shortlist before visiting in person. CMS and consumer advocacy groups consistently note that the rating is one input among several, not a substitute for visits, conversations with current residents and families, and reading the most recent inspection narrative.
Recent methodology changes
CMS has updated the methodology several times since the program launched in 2008, most notably adjusting the staffing weight, incorporating weekend staffing data, and revising the cut-points for star thresholds. Operators following the program should reference the current CMS technical user guide for the active methodology version, which CMS publishes on the agency website.
What the rating does not measure
The rating focuses on regulatory compliance, clinical quality, and staffing. It does not directly measure resident or family satisfaction, food quality, activity programming, or environmental design. Many facilities supplement the CMS rating with independent satisfaction surveys (such as those published through state long-term care ombudsman programs) to give families a more complete picture.