Washington, District of Columbia — Two Senate Democrats are demanding answers about a new CMS inspection program that gives its smallest nursing homes a much lighter touch, warning that the shortcut could leave more than 114,000 residents with weaker protections against abuse and neglect.
Sens. Elizabeth Warren of Massachusetts and Mazie Hirono of Hawaii sent a letter to CMS Administrator Dr. Mehmet Oz on Tuesday questioning the agency’s Risk-Based Survey program, which trims inspection teams and resident samples for facilities the agency deems lower risk. For homes with up to 174 residents, CMS now requires just two surveyors instead of four, along with an initial sample of six residents. Infection control is the only task every abbreviated survey must cover.
Fewer eyes, smaller samples
“Nursing home residents depend on comprehensive, thorough, and unannounced surveys to detect, correct, and prevent abuse, neglect, and substandard care,” the senators wrote. “By allowing these minimal inspections, the new CMS approach weakens oversight and puts nursing home residents at greater risk of mistreatment, injury and abuse.”
The lawmakers argue the eligibility criteria deserve scrutiny too. Drawing on data from the National Consumer Voice for Quality Long-Term Care, they found 27 homes cleared for the program had received a resident abuse designation since September 2025. Another 478 hadn’t undergone a standard survey in more than a year, and 73 had been denied Medicare or Medicaid payments at some point over the past four years.
Roughly half of the newly eligible facilities wouldn’t have qualified under the criteria a year earlier — something the senators say shows past performance doesn’t guarantee continued quality.
A trophy that could mislead
There’s also the question of what families see. Eligible homes now carry a golden trophy icon on CMS’ Nursing Home Care Compare website, and the senators worry consumers will read it as a seal of superior care even though those facilities face less rigorous oversight.
The letter also takes aim at what the criteria leave out: facility finances and ownership. The senators pointed to research linking private equity ownership to worse resident outcomes, and questioned whether the abbreviated process meets federal law’s requirements at all.
They’ve given CMS until Nov. 9 to answer questions about how the agency measures the program’s effectiveness, when it would suspend or remove facilities, and how it plans to keep the trophy designation from misleading consumers.
The pushback lands as enforcement is already softening — federal fines fell even as cited deficiencies rose across nearly every state.
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