CMS Updates Five-Star Technical User’s Guide for July 2026 Refresh

The Centers for Medicare and Medicaid Services (CMS) posted an update to the Five-Star Quality Rating System Technical User’s Guide, effective with the July 2026 refresh. CMS is implementing an increase to the Quality Measure (QM) rating thresholds, increasing each rating threshold by one-half of the average improvement in QM scores (as previously outlined in QSO 19-08-NH).  

For the July 2026 refresh, the average improvement was determined from the period of January 2025 – April 2026. The new rating thresholds are shown in Table 5 of the manual (see below). Note the point thresholds for individual QMs did not change. 

While the thresholds used to assign QM star ratings have increased, the point thresholds for the individual Quality Measures have not changed. As a result, some facilities may need higher overall QM performance to maintain the same QM star rating. 

Questions about the Five-Star Quality Rating System may be sent to regulatory@ahca.org.