The Centers for Medicare & Medicaid Services (CMS) has updated the Five Star Quality Rating System Technical Users’ Guide to input changes to ratings thresholds for Quality Measures (QMs), which will affect some SNFs and their Five-Star scores from a technical basis, regulatory compliance experts say.

The changes are expected to start with the quarterly refresh scheduled for July 29.

“Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide: July 2026” will increase each rating threshold by one-half of the average improvement in QM scores (QSO 19-08-NH), which was previously March 2019 announced by CMS.

“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 [bottom of this article]. Note the point thresholds for individual QMs did not change,” CMS said.

Alicia Cantinieri, managing director, clinical reimbursement and regulatory compliance, Zimmet Healthcare Services Group, said with the updated Five-Star QM domain, some facilities may experience changes to their QM Star rating and, in some cases, their overall Five-Star rating.

“This is most likely to occur for facilities that were near the threshold for a Five-Star QM rating under the previous cut points. With the July refresh, those facilities may receive a lower QM star rating simply because the point ranges used to assign stars have changed, which could also affect their overall Five-Star rating,” she said.

Cantinieri said it is important to recognize that this does not necessarily reflect a decline in the quality of care provided. “Rather, it represents a recalibration of the point thresholds used to determine QM star ratings. In other words, the methodology for assigning stars has changed—not the facility's underlying performance,” she said.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.