The Centers for Medicare & Medicaid Services (CMS) has released an update to the Five-Star Quality Rating System Technical User’s Guide, effective with the July 2026 refresh. As previously outlined in QSO-19-08-NH, CMS is implementing an increase to the Quality Measure (QM) rating thresholds by applying one-half of the average improvement in QM scores observed nationally. For the July 2026 refresh, CMS calculated the average improvement using QM performance data from January 2025 through April 2026. The revised QM star rating thresholds are detailed in Table 5 of the updated Five-Star Quality Rating System Technical User’s Guide. Importantly, the point thresholds for the individual Quality Measures have not changed. However, because the thresholds used to assign overall QM star ratings have increased, facilities may see a slight change in the their current QM star rating. As a result, some nursing facilities could experience a lower QM star rating despite no changes to the scoring thresholds for individual measures which will impact a facility’s overall star rating. Providers should review the updated thresholds and assess current QM performance to understand any potential impact on their Five-Star ratings.