CMS Unveils New Risk-Based Survey System to Reward High-Performing Nursing Homes

The Centers for Medicare & Medicaid Services is rolling out a new oversight approach that could reshape how nursing homes are inspected—and how families choose where to place their loved ones.

In a July 16 announcement, CMS outlined a risk-based survey (RBS) process that will give top-performing facilities a lighter regulatory touch while directing more scrutiny toward struggling operations. The change, which builds on a pilot program tested across 22 states, aims to make better use of limited state survey resources and create clearer incentives for quality improvement.

How the New System Works

Under the risk-based survey approach, nursing homes that meet strict performance criteria will qualify for streamlined inspections. These facilities will still be surveyed at least every 15 months, but the process will require less time and fewer staff to complete.

To qualify, a facility must hit several benchmarks simultaneously:

• Maintain a five-star overall rating on CMS’s Care Compare tool
• Submit accurate data to the agency on schedule
• Show zero citations for harm or substandard care in the most recent survey cycle
• Avoid recent ownership changes

CMS estimates that roughly 12% of the nation’s nursing homes will initially qualify for the program.

The Incentive Structure

Perhaps the most visible change for consumers: qualifying facilities will receive a special icon on the Care Compare website, making it easier for families to spot high performers when researching options.

“Nursing homes care for our seniors, and that care should be of the utmost quality,” said CMS Administrator Dr. Mehmet Oz in the announcement. “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—one of the qualification criteria—creates a direct incentive for facilities to bolster their workforce. Since adequate staffing correlates with multiple quality measures, the program effectively ties regulatory relief to one of the industry’s most pressing challenges.

Budget Pressures Drive the Shift

The move comes as state survey agencies face flat funding at levels unchanged since 2015. By reducing the time and personnel required for standard surveys at high-performing facilities, CMS says states can redirect resources toward complaint investigations and facilities with documented problems.

The risk-based survey process is scheduled to begin in September 2026, following training for state survey agencies. The Care Compare icons for qualifying facilities are expected to appear the same month.

What This Means for Operators

For nursing home administrators, the new system creates a clear path to reduced survey burden—but the criteria are demanding. A single serious citation or data reporting lapse can disqualify a facility, and the requirement for consistent five-star performance means only established, well-run operations are likely to benefit.

The program also raises questions about what happens to facilities that fall just short of the threshold. CMS notes that state agencies and the federal government retain authority to conduct traditional surveys at any RBS-qualifying facility based on resident safety concerns or complaint reports.

The full policy memo is available on CMS’s website for operators and state officials preparing for the September rollout.

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