CMS Launches Risk-Based Survey Process to Reward High-Performing Nursing Homes
About This Article
The Centers for Medicare & Medicaid Services (CMS) announced a new risk-based survey (RBS) process that reduces the frequency and intensity of inspections at top-performing nursing homes, freeing up state resources to focus on facilities where residents face greater health and safety risks.
If you have a parent or loved one in a nursing home, you know how much their safety depends on consistent, thorough oversight. A new federal initiative aims to make that oversight smarter, not weaker, by shifting attention toward the facilities that need it most.
Choosing a nursing home means trusting that someone is watching over the people caring for your loved one. Federal inspectors play a major role in making sure that happens, and CMS just changed how that oversight works for some of the nation's top-rated facilities.
CMS announced the risk-based survey process on July 16, 2026, through Quality, Safety, & Oversight (QSO) memo QSO-26-14-NH, sent to state survey agency directors nationwide. The change streamlines inspections for nursing homes that consistently deliver strong care, while directing more state survey resources toward facilities with documented problems.
In the memo, CMS explains that survey funding set by Congress has not increased since 2015, even as state agencies have seen more than a 20 percent rise in their complaint-survey workload over the same period. Because of that gap, the agency wrote, it is critical to perform the streamlined survey only in higher-performing facilities, so that limited resources can shift toward homes where residents face greater risk.
How Nursing Home Inspections Work Today
Federal law already requires every Medicare- and Medicaid-certified nursing home to undergo a standard health inspection at least once every 15 months, along with complaint investigations whenever concerns arise.
That baseline does not change. The new program changes how those routine inspections are conducted for a small share of consistently high-performing facilities, not whether inspections happen at all.
What Is the Risk-Based Survey Process?
The RBS approach grew out of a pilot program tested across 22 states. It reduces the time and staff required for standard recertification surveys at higher-performing nursing homes. All facilities, regardless of performance, will still be surveyed at least every 15 months, and states retain the authority to launch a full traditional long-term care survey at any facility if complaints or safety concerns arise.
To help you spot these facilities, CMS will add a new icon to qualifying nursing homes on the Care Compare tool at Medicare.gov, making it easier for families to identify consistently high-performing providers during their search.
CMS Administrator Dr. Mehmet Oz framed the change as part of a broader push to sharpen accountability across the industry.
"Nursing homes care for our seniors. CMS wants to recognize top performers while pushing lower-rated facilities to improve." — CMS Administrator Dr. Mehmet Oz.
Why CMS Says the Change Matters
CMS points to three main benefits of the new system:
- Greater efficiency. States can redirect staff time toward serious complaint investigations without needing additional funding.
- Budget relief. Congress has kept survey budgets flat since 2015, so this approach stretches existing resources further.
- Incentives for improvement. Because a facility's staffing star rating is one of the qualifying criteria, the program gives nursing homes a financial and reputational reason to invest in staffing levels, an area closely tied to quality outcomes.
An Independent Perspective
Consumer advocates have long argued that strong, consistent oversight is essential because conditions in a nursing home can change quickly due to staffing shortages, ownership changes, or management turnover. CMS says complaint investigations and traditional surveys remain available at any RBS-qualifying facility whenever resident safety concerns emerge.
Provider groups have generally welcomed a more targeted approach. Speaking about the broader risk-based survey effort as it was being piloted, LeadingAge Vice President of Health Policy Janine Finck-Boyle noted that the current survey and certification system has long shown inconsistencies from state to state, and said a shorter, more targeted process could reduce some of those variances.
Her comments, made at a 2024 LeadingAge federal policy discussion, reflect ongoing input from providers as CMS refined the program ahead of this week's national rollout.
Qualifying Criteria
Not every nursing home will see lighter oversight. To qualify for a risk-based survey, a facility must meet strict standards every quarter, including:
- A five-star overall rating on Care Compare
- Accurate and timely data submission to CMS
- Zero citations for harm or substandard care in its most recent survey cycle
- No recent change in ownership
CMS estimates roughly 12 percent of nursing homes nationwide will qualify when the program begins.
When the Program Takes Effect
State survey agencies will receive training during August and September 2026, ahead of the nationwide launch on September 8, 2026. CMS expects the list of qualifying facilities to become publicly available on Care Compare and its Provider Data Catalog by September 30, 2026, with the new performance icon appearing on qualifying facilities' profile pages shortly after.
The memo also includes a state-by-state breakdown of expected qualification rates. In Illinois, CMS projects that only about 8 percent of the state's 667 nursing homes, roughly 54 facilities, will qualify for the RBS initially, below the 12 percent national average. The most common disqualifying factor nationwide, beyond the five-star rating requirement, is a health inspection score above the state median, followed closely by a staffing rating below three stars.
What This Means for Families
If you're researching care options for a parent or spouse, this update gives you one more data point, but it shouldn't replace your own due diligence. A facility that qualifies for a lighter survey schedule has met a high bar recently, but conditions can change quickly in long-term care settings.
Continue checking Care Compare ratings, reading recent survey results, and, where possible, visiting in person before making a decision.
Use our Cost of Care Calculator to see what nursing home care costs in your area, and browse our Caregiver Directory to compare local facilities and services. Our Education Center also has more guidance on evaluating nursing home quality and planning for long-term care.
Frequently Asked Questions
What is the CMS risk-based survey (RBS) process?
The risk-based survey (RBS) process is a new inspection approach from the Centers for Medicare & Medicaid Services (CMS) that streamlines routine recertification surveys for a small group of consistently high-performing nursing homes. The goal is to allow state survey agencies to spend more time investigating facilities where residents may face greater health and safety risks.
Will the new process reduce resident protections?
CMS says no. The agency emphasizes that complaint investigations and full traditional surveys remain available whenever resident safety concerns arise, even for nursing homes participating in the streamlined survey program.
When does the new survey process begin?
State survey agencies will receive training during August and September 2026. Nationwide implementation begins September 8, 2026, with qualifying facilities expected to appear on Care Compare and the CMS Provider Data Catalog by the end of September.
Does a qualifying nursing home automatically provide the best care?
Not necessarily. While qualifying facilities have demonstrated strong recent performance, no rating or designation guarantees future quality. Staffing changes, management turnover, and other factors can affect care over time.
Does this mean some nursing homes will no longer be inspected?
No. Every Medicare- and Medicaid-certified nursing home must still receive a standard health inspection at least once every 15 months. Complaint investigations and full surveys can also occur at any time if concerns about resident care arise.
Which nursing homes qualify for the streamlined surveys?
To qualify, a nursing home must consistently meet several high-performance standards, including:
- A five-star overall rating on Care Compare
- Accurate and timely reporting of required CMS data
- No citations for resident harm or substandard quality of care during the most recent survey cycle
- No recent change in ownership
Facilities must continue meeting these standards on an ongoing basis.
Will families be able to identify qualifying facilities?
Yes. CMS plans to add a special performance icon to qualifying nursing homes on the Medicare Care Compare website, making it easier for consumers to recognize facilities participating in the program.
Why might a nursing home fail to qualify?
The most common reasons include:
- Not earning an overall five-star rating.
- A health inspection score above the state median.
- Staffing ratings that are below CMS requirements.
- Recent citations involving resident harm.
- A recent ownership change.
Should families still review inspection reports?
Absolutely. Families should continue to:
- Review Care Compare ratings.
- Read recent inspection and complaint reports.
- Visit the nursing home in person.
- Speak with administrators, staff, residents, and families before making a decision.
The new CMS designation should be viewed as one tool—not the only factor—in evaluating a facility.
How can families compare nursing homes?
In addition to reviewing CMS Care Compare ratings and inspection reports, compare staffing levels, specialized services, rehabilitation programs, resident satisfaction, and proximity to family. Visiting the facility and asking detailed questions remain among the most important steps in choosing quality long-term care.
Why is CMS changing the inspection process?
CMS says survey resources have become increasingly strained. While congressional funding for state survey agencies has remained essentially flat since 2015, complaint investigations have increased by more than 20 percent. The new process is intended to focus limited resources where they are needed most.
How many nursing homes are expected to qualify?
CMS estimates that approximately 12 percent of nursing homes nationwide will initially qualify for the risk-based survey process.
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