The Centers for Medicare & Medicaid Services (“CMS”) has announced the nationwide implementation of a new Risk-Based Survey (“RBS”) process for qualifying nursing homes beginning September 8, 2026. CMS Memorandum QSO-26-14-NH explains that the RBS is intended to allow State Survey Agencies (“SAs”) to use fewer survey resources at higher-performing facilities and redirect resources toward complaint investigations and facilities where residents may face greater risk of harm.
CMS estimates that approximately 12% of nursing homes nationwide currently qualify. Qualifying facilities will also receive a high-performing facility icon on Nursing Home Care Compare, creating a new public-facing distinction in addition to the traditional Five-Star Quality Rating System.
What Is the Risk-Based Survey Process?
The RBS is a modified version of the Long-Term Care Survey Process used for standard recertification surveys. CMS tested the process beginning in 2023 in 22 states and more than 100 facilities. According to CMS, the pilot produced findings comparable to the traditional survey process while requiring roughly half the onsite time and fewer surveyors.
The RBS still includes a review of all required areas, but uses fewer survey activities and a smaller resident sample. Nursing homes remain subject to a standard recertification survey at least once every 15 months. In addition, an SA or CMS may require the traditional survey process at an otherwise qualifying facility when health and safety concerns exist, including concerns arising from complaints or survey performance.
RBS Qualifying Criteria
To appear on CMS’s quarterly RBS-qualified facility list, a nursing home must avoid each of the following disqualifying conditions:
- An overall rating below five stars;
- A staffing rating below three stars;
- Any citation for Actual Harm, Immediate Jeopardy or Substandard Quality of Care during the last survey cycle (the last standard survey and complaint investigations during the prior year);
- More than 18 months without a standard survey;
- Any staffing waiver in effect;
- A failed Payroll-Based Journal (“PBJ”) staffing data audit;
- A failed Minimum Data Set (“MDS”) resident assessment audit;
- A health inspection score above the 50th percentile in the state (lower scores indicate better performance);
- Two or more residents age 65 or older coded with a schizophrenia diagnosis after admission when the diagnosis was not present at admission;
- A change in ownership since the last standard survey; or
- Designation as a Special Focus Facility candidate.
How Eligibility and Survey Selection Will Work
At the end of each calendar quarter, CMS will provide each SA with a list of RBS-qualified facilities. A facility generally remains eligible for six months after the SA receives the list, unless a later event triggers disqualification.
Before beginning an RBS, the SA must confirm that no intervening disqualifying event has occurred. An SA must convert the survey to the traditional Long-Term Care Survey Process if, before the RBS begins, the facility has: (1) an intake investigation citation at Actual Harm, Immediate Jeopardy, abuse at any level or Substandard Quality of Care; (2) a pending intake triaged at Immediate Jeopardy; (3) more than three pending non-Immediate Jeopardy active intakes triaged at medium or higher; (4) a CMS-approved nursing waiver; or (5) a change in ownership since the last standard survey.
CMS emphasizes that placement on the qualifying list does not guarantee that an RBS will be used. SAs retain discretion to use the traditional process based on resident health and safety concerns, and CMS may direct an SA to do so.
Public Identification of Qualifying Facilities
Beginning September 30, 2026, CMS expects to make the qualifying facility list publicly available through the Provider Data Catalog and Nursing Home Care Compare. CMS will place an icon on the profile of a qualifying facility; the national association summary describes the icon as a gold trophy. The icon will remain while the facility is eligible. CMS will also identify completed RBS surveys through a footnote on the Care Compare survey-results page, an indicator on the CMS-2567 and the applicable Provider Data Catalog files.
CMS cautions that timing and data-processing differences may cause the public icon to differ from the list provided directly to an SA. Survey agencies are instructed to rely on CMS’s quarterly lists and the applicable disqualifying criteria, not solely on what appears on Care Compare.
Practical Takeaways
- Confirm the underlying data. Review the facility’s current five-star ratings, staffing rating, health inspection score, PBJ data, MDS data, survey history and ownership information. Because eligibility is data-driven and evaluated quarterly, inaccurate or delayed submissions may affect qualification.
- Identify the most likely barriers to qualification. CMS reports that, after the five-star requirement, a staffing rating below three stars is one of the most common reasons facilities do not qualify. Facilities seeking eligibility should evaluate staffing performance and the operational factors affecting the staffing rating.
- Do not treat RBS status as reduced compliance risk. The RBS remains a standard recertification survey, and CMS states that the pilot identified noncompliance and resident risk at rates comparable to the traditional process. A qualifying facility should remain prepared for either survey process.
- Monitor intervening events. Complaints, facility-reported incidents, survey citations, staffing waivers and ownership changes can cause a facility to lose RBS eligibility after it appears on a quarterly list.
- Continue survey readiness efforts. Facilities should maintain routine mock surveys, documentation, quality assurance and performance improvement, staffing and complaint management processes. The streamlined protocol should not change the facility’s obligation to maintain continuous compliance with all federal requirements.
Key Dates
- July 16, 2026 – CMS issued QSO-26-14-NH; the memorandum is effective immediately and should be communicated to appropriate staff within 30 days.
- August and September 2026 – CMS surveyor training and office hours support.
- September 8, 2026 – Nationwide RBS implementation begins for eligible facilities, based on SA survey schedules.
- September 30, 2026 – CMS expects qualifying-facility information and the Care Compare icon to become publicly available.
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