Updates to Five-Star Quality Measure Thresholds Return

The Centers for Medicare & Medicaid Services (CMS) has updated the Five-Star Quality Rating System Technical Users' Guide to reflect changes to the Quality Measure (QM) domain rating thresholds, which will take effect with the quarterly Five-Star refresh scheduled for July 29, 2026.

These changes are the result of a CMS policy first announced in March 2019, establishing a process to update Quality Measure domain rating thresholds every six months. Under this policy, thresholds are adjusted at a rate equal to half of the previous six-month period's improvement in national performance.

Policy Implications

It is important to note that this policy only affects the overall Quality Measure domain rating thresholds and does not change the thresholds for the individual quality measures that make up the domain.

Prior to this policy, CMS updated Quality Measure thresholds on an irregular basis, often resulting in larger changes when updates finally occurred. CMS indicated that more frequent, incremental adjustments would better reflect national performance improvements while encouraging organizations to pursue continuous quality improvement.

Although the policy has remained in effect, it has been applied infrequently over the past several years. Threshold updates were suspended during the COVID-19 pandemic, and subsequent national performance trends did not support the planned adjustments. CMS resumed the policy with the January 2025 Five-Star refresh, and continued improvements in quality measure performance have resulted in another threshold adjustment for July 2026.

If national performance continues to improve, providers can anticipate another update to the Quality Measure domain rating thresholds in January 2027.

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