CMS Is Testing Lighter Inspections for Top Nursing Homes While Steering More Scrutiny to Troubled Facilities

Baltimore, Maryland — CMS says it is testing a new inspection approach that would allow a small share of higher-performing nursing homes to receive more focused standard surveys, while shifting more state resources toward facilities where residents may face greater risk.

The change appears in an updated CMS nursing home guidance page published in late April. The agency said it is working with states over the next several months to test what it calls a risk-based survey approach, or RBS. Under that model, nursing homes with stronger compliance and quality histories could receive a narrower recertification survey, while lower-performing facilities would draw more attention.

CMS said the pool would be limited to as many as 10% of nursing homes within a state. To qualify, facilities would need a record that points to lower risk, including fewer noncompliance citations, stronger staffing, fewer hospitalizations, and no pending immediate jeopardy investigations tied to resident harm or abuse.

The move builds on the agency’s broader push to target oversight where it believes resident safety concerns are greatest. It also comes as the federal government continues to wrestle with survey capacity. CMS said the budget for survey and certification has remained flat at $397 million since 2015, a funding backdrop the agency cited as one reason it wants to use limited resources more selectively.

That pressure has already been showing up across the sector, including in new federal scrutiny of nursing home staffing records and a wider compliance push tied to quality reporting and inspections.

Resident safety remains the line

CMS stressed that the focused-survey test would not apply to complaint investigations. The agency also said any sign of resident safety trouble during a risk-based survey would trigger an immediate expansion of the review.

That matters because providers may welcome relief from lengthy standard surveys, but the policy still leaves little room for error. A facility that looks stable on paper could quickly lose that status if staffing, hospital transfer patterns, or serious deficiencies begin to move in the wrong direction.

For operators, the message is mixed. Better-performing buildings may get a more tailored review if the pilot expands. At the same time, CMS is making clear that homes with weaker quality histories should expect more concentrated oversight, not less.

The agency said it will post formal updates and any official memoranda as testing with states moves forward.