There will be a slew of changes that will affect how nursing homes are inspected, how oversight resources are allocated, how quickly serious problems may be identified, and how families evaluate facilities. As a result of these upcoming challenges, families that have raised concerns about a loved one's care or are selecting a nursing home should understand what the new system does and does not mean.

What Is the Risk-Based Survey?

State survey agencies currently use the long-term care survey process, and comprehensive surveys are generally conducted at least once every 15 months. Additional investigations may be triggered by complaints.

But CMS is changing the process. Survey budgets have not increased since 2015, and complaint-driven investigations have increased by more than 20%. Because of this, state agencies have faced overdue inspections and growing complaint backlogs, as well as limited resources for high-risk facilities.

Under the new risk-based survey, qualifying high-performing nursing homes will receive a shorter, streamlined survey. The streamlined process is intended to free surveyors to focus on facilities with documented problems. CMS piloted the process in 22 states, and it estimates that approximately 12% of nursing homes will initially qualify.

Which Facilities Qualify?

To be eligible for the streamlined survey, a facility must clear a demanding set of quality benchmarks, including:

• A five-star overall CMS quality rating
• At least a three-star staffing rating
• No citations for actual harm, immediate jeopardy, or substandard quality of care in the last survey cycle
• No overdue standard survey (more than 18 months since the last one)
• No active staffing waivers
• Passing audits of both payroll-based staffing data and resident assessment (MDS) data
• A Health Inspection Score in the better-performing half of its state
• No recent change in ownership
• No pattern of new schizophrenia diagnoses among long-stay residents 65 and older after admission

A facility that qualifies remains eligible for six months, but CMS or the state agency can revoke that status at any time if new complaints, an Immediate Jeopardy finding, or an ownership change surfaces before the survey is conducted. Qualifying facilities will also carry a visible icon on the Care Compare website, giving families an at-a-glance signal, separate from the familiar five-star rating that a facility has cleared this additional bar.

For nursing home operators, the new criteria creates a direct financial and reputational incentive to invest in staffing levels, accurate data reporting, and consistent survey performance, which are the qualifying factors that CMS has built into the program. Facilities should also be aware that disqualification can happen quickly.

Looking Ahead

CMS will begin publishing quarterly lists of RBS-qualified facilities to state agencies, with the qualifying facility list and icon becoming publicly visible on Care Compare starting September 30, 2026. Surveyor training is scheduled throughout August and September 2026, ahead of the program's nationwide launch.

As this new oversight structure takes effect, you should continue monitoring how it affects both accountability for nursing home operators and the practical realities families face in advocating for loved ones in long-term care.

If you own or operate a long-term care facility, Foster Swift’s healthcare attorneys are available to answer questions and respond to the results of CMS Surveys:

• Jennifer Van Regemorter…616.796.2502…jvanregenmorter@fosterswift.com
• Alexander S. Rusek… 517.371.8153… arusek@fosterswift.com
• Tony Dalimonte… 248.785.4733… adalimonte@fosterswift.com