The Centers for Medicare and Medicaid Services (CMS) is launching a new risk-based survey process to “modernize” nursing home oversight by focusing inspection resources where they are most needed while recognizing high-performing facilities, the agency said Thursday.

The agency noted that the changes to the survey process are driven by limited funding for nursing home surveys over the past decade. The federal budget for survey activities has remained largely flat even as state survey agencies have faced growing workloads, creating challenges for surveyors and delaying standard inspections. CMS said these delays can increase the risk of harm to nursing home residents.

“[Since 2015], there has been over a 20% increase in SAs’ obligation to conduct complaint surveys, in addition to the traditional cost-of-living increase that occurs over a decade,” CMS said in the memo. “The budgetary constraints have severely hindered SAs’ ability to hire staff to conduct the required surveys in nursing homes.”

Under the new Risk-Based Survey (RBS) approach, higher-performing nursing homes will undergo streamlined standard recertification surveys, allowing state agencies to dedicate more time and staff to facilities where residents may face greater health and safety risks.

All nursing homes will continue to receive a standard survey at least every 15 months, and traditional surveys may still be conducted at RBS-qualifying facilities when complaints or other concerns arise.

The RBS will take about half the time and require fewer surveyors while still enabling the evaluation of required compliance areas, CMS said.

Facilities eligible for the RBS will be selected based on strong quality indicators, such as high staffing levels and a history of fewer deficiencies. CMS estimates that about 12% of nursing homes will initially qualify for the program.

Eligibility requires meeting rigorous quarterly standards, including a 5-star overall Care Compare rating, accurate data reporting, no citations for resident harm or substandard quality of care during the previous survey cycle, and no recent ownership changes.

For higher-performing facilities, CMS will place an icon on the Care Compare tool on Medicare.gov, making it easier to identify high-performing nursing homes.

Implementation of the new approach is scheduled to begin in September 2026 following state agency training.

The RBS initiative builds on a successful pilot program conducted in 22 states and is designed to improve the efficiency and effectiveness of nursing home surveys, CMS stated in a memo.

“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.” 

A ‘significant win’ for all 

Nursing homes have long advocated for changes to the survey process. The system has been plagued by delays, contributing to financial challenges for providers and administrative burdens for care teams at skilled nursing facilities (SNFs). It has also resulted in Care Compare ratings that often lag behind current facility performance by several years.

Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit and mission-driven providers of aging services including nursing homes, said that CMS’ revised approach to nursing home surveys is a win for all parties engaged in it. 

“CMS’ decision to implement a Risk-Based Survey (RBS) process nationally following years of careful testing and evaluation is a significant win for nursing home residents and families; for providers, including our nonprofit and mission-driven members; and for state regulators,” Smith Sloan said in an emailed statement to Skilled Nursing News. “Risk-based survey is a critical step and a component of our regulatory reform agenda that we’ve asked for continuously in recent years, in comments to and in meetings with CMS; we fully support the agency’s goals.” 

Clif Porter, president and CEO of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), also said that the move is one the association has long backed. 

“We applaud CMS’s nationwide expansion of the Nursing Home Risk-Based Survey, an approach AHCA has long supported to make the survey process more efficient and effective,” Porter said in an emailed statement to SNN. “This initiative upholds accountability while further incentivizing quality improvement by recognizing high-performing facilities. We look forward to working with CMS and state survey agencies to support a successful implementation as well as explore additional ways to improve the oversight system so that it drives the results for residents we all hope to achieve.” 

CMS’ plan for a new icon on Care Compare to call attention to high performers was especially welcomed by Smith Sloan.

“Highlighting the qualifying nursing homes on Care Compare is a meaningful and positive recognition beyond the traditional star ratings for high performers. Our members share CMS’ goal of ensuring quality care; those who meet high standards deserve praise,” she said.