The Centers for Medicare & Medicaid Services (CMS) has updated the Five Star Quality Rating System Technical Users’ Guide to reflect changes to ratings thresholds for the Quality Measures domain, expected with the quarterly refresh scheduled for July 29, 2026.
These changes are based on a policy change dating back to March 2019 when the agency announced plans to conduct regular updates every six months. The policy states that Quality Measure domain rating thresholds will be updated every six months at a rate of half the previous cycle’s rate of improvement. Ratings thresholds for individual quality measures within the domain are not impacted by this policy.
Prior to the implementation of this policy, threshold updates were made without regularity, often resulting in more significant changes than CMS anticipated more regular updates would provide. Additionally, CMS noted that regular updates would incentivize continuous quality improvement.
Updates to the ratings thresholds have not been implemented often over the seven years since the policy was announced, though it remained in effect. The policy was temporarily suspended for a period of time during the COVID-19 public health emergency, then later performance did not allow for the types of threshold updates described in the policy.
An update was implemented in January 2025 and ratings have steadily improved since that time, resulting in the conditions to once again apply this policy with the July 2026 refresh. Assuming performance continues in this trend, nursing homes can expect another adjustment to Quality Measure domain rating thresholds in January 2027. The LeadingAge Report Portal will be updated following the release of the July quarterly refresh data and will reflect the domain rating threshold changes.
