Lawmakers are raising concerns about the Centers for Medicare and Medicaid Services’ (CMS) new Risk-Based Survey program for nursing homes, warning in a letter Tuesday that shortened inspections could put thousands of residents at risk.
In the letter addressed to CMS Chief Dr. Mehmet Oz, Sens. Elizabeth Warren, D-Mass., and Mazie K. Hirono, D-Hawaii, expressed concerns about the gaps stemming from reduced inspections, fewer surveyors and smaller resident samples. They noted that infection control is the only mandatory facility task under the abbreviated survey process
“Nursing home residents depend on comprehensive, thorough, and unannounced surveys to detect, correct, and prevent abuse, neglect, and substandard care,” the letter notes. “By allowing these minimal inspections, the new CMS approach weakens oversight and puts nursing home residents at greater risk of mistreatment, injury and abuse.”
The letter said that the new survey process could jeopardize the safety and well-being of an estimated 114,300 residents, noting data from the National Consumer Voice for Quality Long-Term Care.
The senators also questioned whether the program’s eligibility criteria were reliable in identifying high-quality facilities. Citing data from Consumer Voice, they noted that 27 eligible homes had received a resident abuse designation since September 2025, 478 had not undergone a standard survey in more than a year, and 73 had experienced Medicare or Medicaid payment denials in the past four years.
They also pointed out that about half of the newly eligible facilities would not have qualified a year earlier, and that past performance did not guarantee continued quality.
The senators warned that a golden trophy icon on CMS’ Nursing Home Care Compare website could mislead consumers into believing that the designated facilities provided superior care, despite receiving less rigorous oversight.
CMS’ Risk-Based Survey program uses an insufficient number of surveyors. For facilities with up to 174 residents, CMS requires just two surveyors instead of four and an initial sample of six residents.
“[G]iven that federal law requires evaluation of these matters, it is unclear if the RBS meets statutory requirements,” the letter states, noting the senators concern that CMS’ criteria ignored facilities’ finances and ownership structures, despite links between private equity ownership and worse resident outcomes.
Warren and Hirono requested answers from Oz by Nov. 9, 2026 on the program’s effectiveness, monitoring and suspension criteria as well as plans for publicly reporting comparative outcomes. They also asked how CMS would respond if eligible facilities failed to meet program requirements and how the agency would ensure consumers are not misled by the trophy designation.
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