Four Senate Democrats are questioning whether the Centers for Medicare & Medicaid Services' (CMS) new Risk-Based Survey program adequately protects nursing home residents. Their inquiry comes alongside broader scrutiny by Senate Finance Committee Democrats of nursing home ownership, spending, and quality, and a request for public input on changes to the nation's long-term care system.

In an October 26, 2026 letter to CMS Administrator Mehmet Oz, Sens. Elizabeth Warren (D-MA), Mazie Hirono (D-HI), Kirsten Gillibrand (D-NY), and Richard Blumenthal (D-CT) raised concerns about the scope of abbreviated surveys, the criteria used to identify eligible nursing homes, and whether the process meets federal survey requirements. They requested answers by November 9.

CMS began nationwide implementation of the Risk-Based Survey program on September 8. The program allows qualifying nursing homes to receive shorter, more focused recertification surveys with smaller survey teams. Eligibility criteria include a five-star overall rating, at least a three-star staffing rating, and no citations for actual harm, immediate jeopardy, or substandard quality of care during the last survey cycle. CMS reviews eligibility quarterly.

CMS describes the approach as a way to direct limited state survey resources toward nursing homes where residents face greater risks. All nursing homes remain subject to surveys at least every 15 months, and state agencies and CMS can use the traditional survey process at qualifying homes when resident health and safety concerns warrant it.

The senators argue that a narrower review could miss abuse, neglect, or other deficiencies. Citing information provided by the National Consumer Voice for Quality Long-Term Care, they note that some eligible nursing homes had histories of abuse citations or payment denials. Their questions ask CMS to explain the evidence supporting the program, how the agency will identify missed or delayed findings of resident harm, and what would trigger changes to or suspension of the program. They also question the use of a trophy icon on Care Compare to identify qualifying nursing homes.

LeadingAge has advocated for risk-based surveys as part of broader efforts to modernize survey and certification and focus oversight where it can best protect residents. In our June 2025 comments to CMS, we supported the concept and recommended nationwide implementation. Our 2026 policy platform continues to call for risk-based surveys, improved consistency and accuracy in enforcement, and a stronger focus on resident outcomes and sustainable quality improvement.

The letter also connects directly to Senate Finance Committee Ranking Member Ron Wyden's (D-OR) October 16 long-term care request for information. The RFI seeks feedback on making home care affordable and accessible, improving nursing home quality, and strengthening the long-term care workforce. Its nursing home section specifically asks about the impact of risk-based surveys, whether CMS should continue the approach, and whether Congress should consider other survey frameworks. It also explores ownership transparency, consolidated financial reporting, and oversight of transactions between nursing homes and related businesses. Responses are due December 18 and will inform future policymaking and legislative drafting.

On October 29, Sen. Wyden and Sens. Sheldon Whitehouse (D-RI), Andy Kim (D-NJ), and Warren added to that scrutiny with an investigative report on nursing home ownership and spending. The report examines private equity and other corporate structures and argues that gaps in financial transparency and enforcement allow some operators to divert public dollars from staffing and resident care. It also raises concerns about survey backlogs and the effectiveness of existing oversight.

Taken together, these developments place survey reform within a wider debate over how long-term care is financed, delivered, and overseen. LeadingAge will continue to engage with the Senate Finance Committee and the authors of the letter to educate lawmakers and their staff on the benefits of the Risk Based Survey program and our members' positive experiences, while working to ensure that the program's implementation does not put the residents we serve at risk.