CMS begins risk-based nursing-home surveys for top-performing facilities
The Centers for Medicare & Medicaid Services is beginning a national risk-based survey process for nursing homes in September 2026. The change may shorten routine recertification surveys for a limited group of consistently higher-performing facilities, but it does not exempt them from federal or state oversight.
CMS estimates that about 12% of nursing facilities will qualify initially. Those facilities may receive a more focused standard survey that takes less time and requires fewer survey staff than the traditional process. CMS says the goal is to free state survey resources for facilities where residents face greater health and safety risks.
What is changing
Under the new approach, qualifying nursing homes will still receive a standard recertification survey. The difference is that the review will use a more focused process covering required areas of a standard survey.
CMS announced the policy on July 16, 2026, and said national implementation would begin in September after state-agency training. The agency said the approach builds on a pilot conducted across 22 states, but the national program is too new for an independent assessment of its results.
Which nursing homes may qualify
Eligibility is assessed using current quality and compliance information. CMS says a facility must meet several criteria, including a five-star overall rating on Care Compare, accurate data submission to CMS, zero citations indicating harm or substandard quality of care in the last survey cycle, and no recent ownership changes.
CMS’s guidance also describes other quality and compliance indicators, such as staffing and the absence of pending investigations involving immediate jeopardy for serious harm. Eligibility is reviewed quarterly, so a facility’s status can change. The approximately 12% figure is an initial CMS estimate, not a fixed share that every state or facility should expect to meet.
What the process does not change
Every nursing home must continue to be surveyed at least once every 15 months. A risk-based survey is still an inspection; it is not a waiver from oversight.
The risk-based process applies to standard recertification surveys, not complaint surveys. A complaint involving possible neglect, abuse, unsafe care or another serious problem can still lead to a separate investigation under the applicable complaint process.
CMS says that if inspectors encounter concerns about resident safety during a risk-based survey, the review must be expanded immediately. Resident safety remains the priority regardless of which survey process is used.
Why states may use the approach
CMS says survey-and-certification budgets set by Congress have remained flat at about $397 million since 2015. The agency’s rationale is that spending less time and using fewer staff on focused surveys at qualifying facilities could give state agencies more capacity to conduct timely oversight at higher-risk facilities and investigate serious complaints.
Those are CMS’s stated efficiency and quality-improvement goals. There is not yet enough national experience to determine whether the new process improves targeting without missing safety problems.
What families may see on Care Compare
CMS says qualifying facilities are expected to receive a new designation on Medicare’s Care Compare tool during September 2026. Because the rollout is scheduled rather than complete, families should check the live tool to see whether the designation has appeared for a particular facility.
The designation should be treated as one screening tool, not a guarantee of safety or quality. CMS’s existing Five-Star system includes separate overall, health-inspection, staffing and quality-measure ratings, and no single rating captures every factor families may want to consider.
How to compare nursing homes
Families should review a facility’s ratings, recent inspection deficiencies, staffing information, ownership history and complaint history. They can also ask how staffing varies by shift, how the facility responds to complaints and whether identified problems have been corrected.
A Care Compare rating is a starting point. Families should visit the facility when possible and consult a state or local long-term-care advocate before making a placement decision.
What to watch next
The next milestones are the September implementation, the appearance of Care Compare designations and the experience of state survey agencies using the focused process. The key question is whether shorter routine surveys at qualifying facilities free meaningful capacity for higher-risk homes while preserving the complaint and safety safeguards that apply across the nursing-home system.
Sources
Look for updates to this story
Discover more from Interactive News
Subscribe to get the latest posts sent to your email.