CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement

CMS Modernizes Nursing Home Oversight with New Risk-Based Survey Approach Designed to Highlight High Performance, Encourage Improvement

The Centers for Medicare & Medicaid Services (CMS) is introducing a more streamlined review process for higher-performing nursing homes as well as an easier way for consumers to discover them when searching the CMS website. Released today, the Quality, Safety, & Oversight (QSO) Memo outlines this risk-based survey (RBS) process that strategically directs state agencies' limited resources where they are needed most - by focusing fewer resources on the nation's higher-performing nursing homes so states can address issues in nursing homes where residents' health and safety are at greater risk. To identify these higher-performing facilities, CMS will place an icon on the Care Compare tool on Medicare.gov.

Building on a successful pilot program conducted across 22 states, the new risk-based survey process is designed to improve efficiency and effectiveness in nursing home oversight. This approach reduces both the time required and the number of staff members needed to conduct standard recertification surveys at the higher-performing facilities in the country. All facilities will continue to be surveyed at least every 15 months. State agencies and CMS may still conduct the survey using the traditional long-term care (LTC) survey process in any RBS-qualifying facility, based on concerns related to residents' health and safety, such as complaint reports.

"Strengthening oversight of long-term care facilities is one of many top priorities at CMS," said CMS Administrator Dr. Mehmet Oz. "Nursing homes care for our seniors, and that care should be of the utmost quality. At CMS, we are continually looking for ways to recognize excellence for top performers and to encourage lower performers to improve."

Key benefits of the new risk-based survey approach include:

• Greater Efficiency - States can decrease time spent conducting standard surveys and conduct serious complaint investigations without requiring additional funding.
• Budget Relief - Because annual survey budgets, which are set by Congress, have remained flat since 2015, this approach maximizes the impact of existing resources.
• Creates Incentives for Quality Improvement - The program is designed to encourage facilities to improve the quality of care they provide to qualify for the RBS and earn the corresponding icon on CMS's Care Compare tool on Medicare.gov. For example, because the staffing star rating is one of the qualification criteria - and adequate staffing is closely linked to many aspects of quality - the program creates an incentive for facilities to strengthen their staffing levels.

About 12% of all nursing facilities will qualify for the new risk-based survey process initially.

To qualify for the risk-based assessment, a nursing home must meet several rigorous criteria quarterly, including a five-star overall facility rating on CMS's Care Compare site, accurate data submission to CMS, zero citations indicating harm or substandard quality of care in the last survey cycle, and no recent ownership changes. Moving forward, qualified facilities will be designated as such on Care Compare at Medicare.gov, where users can compare different provider types.

The risk-based survey implementation is scheduled to begin in September 2026, following state agency training. The designations for high-performing facilities are expected to appear in Care Compare in September 2026.

To read the QSO Memo, visit: https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-cms-locations/nursing-home-risk-based-survey-national-implementation

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