Washington, D.C. — After months of preparation and state agency training, the Centers for Medicare & Medicaid Services is officially rolling out its risk-based survey program nationwide this month. Starting September 8, approximately 12 percent of nursing homes across the country will qualify for streamlined federal inspections — and a new “high performer” icon on CMS’s Care Compare website.
The program, outlined in QSO Memo QSO-26-14-NH released July 16, represents a significant shift in how federal oversight works for the nation’s highest-rated facilities. Rather than applying the same inspection intensity to every nursing home, CMS is directing state survey agencies to focus their limited resources on facilities where residents face the greatest health and safety risks.
How Facilities Qualify
Earning a spot in the risk-based survey program is not automatic. Facilities must meet strict criteria that are evaluated quarterly. To qualify, a nursing home needs a five-star overall rating on Care Compare, accurate and timely data submission to CMS, zero citations for harm or substandard quality of care in its most recent survey cycle, and no recent ownership changes.
According to CMS estimates, roughly 12 percent of the nation’s nursing homes will initially qualify. The percentage varies by state — in Illinois, for example, only about 8 percent of facilities are projected to meet the standards initially.
What Changes for Qualifying Facilities
For facilities that make the cut, the risk-based survey means a more focused inspection process requiring less onsite time and a smaller survey team. The streamlined approach grew out of a pilot program tested across 22 states, and CMS says it will allow state agencies to conduct complaint investigations and overdue standard recertification surveys without requiring additional funding.
Importantly, all facilities will continue to be surveyed at least once every 15 months as federal law requires. State agencies and CMS retain the authority to conduct traditional full surveys at any RBS-qualifying facility based on resident safety concerns or complaint reports.
The “Gold Trophy” Icon
Perhaps the most visible element of the new program is the icon that will appear on qualifying facilities’ Care Compare profiles. CMS Administrator Dr. Mehmet Oz said the designation is designed to help families identify consistently high-performing providers while creating incentives for lower-rated facilities to improve.
“Nursing homes care for our seniors, and that care should be of the utmost quality,” Oz said in announcing the program. “At CMS, we are continually looking for ways to recognize excellence for top performers and to encourage lower performers to improve.”
The staffing star rating is one of the qualification criteria, which CMS says creates an incentive for facilities to strengthen staffing levels — an area closely linked to quality outcomes.
Why Now?
The push for risk-based surveys comes as state survey agencies face mounting workload pressures. According to the QSO memo, survey budgets set by Congress have remained flat since 2015, even as state agencies have seen more than a 20 percent increase in their complaint-survey workload over the same period.
By reducing the time and staff required for standard surveys at higher-performing facilities, CMS says states can redirect resources toward facilities with documented problems and serious complaint investigations. This builds on other recent CMS initiatives, including changes to prior authorization requirements that aim to reduce administrative burdens on providers.
What Families Should Know
The new icons are expected to appear on Care Compare by September 30, 2026. For families researching nursing home options, the designation offers an additional data point — but advocates caution that it should not replace thorough due diligence.
A facility’s conditions can change quickly due to staffing shortages, ownership changes, or management turnover. Families should continue reviewing Care Compare ratings, reading recent survey results, and visiting facilities in person when possible before making decisions.
The risk-based survey program represents CMS’s attempt to make nursing home oversight more efficient while maintaining accountability. Whether it succeeds in directing resources where they’re needed most — without missing emerging problems at previously high-performing facilities — will become clearer as the program takes effect this fall.
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