Beginning September 8, 2026, the Centers for Medicare & Medicaid Services will implement a new Risk-Based Survey, or RBS, process for qualifying nursing homes nationwide.
The approach is intended to allow state survey agencies to spend less time in facilities with a strong history of performance and redirect limited survey resources toward complaint investigations, overdue surveys, and nursing homes where residents may face greater risk.
CMS estimates that approximately 12% of nursing homes will initially qualify.
The RBS is a modified version of the traditional Long-Term Care Survey Process used for standard recertification surveys.
Qualifying facilities will still be reviewed for compliance with federal health and safety requirements, but the survey may involve:
CMS tested the process in more than 100 facilities across 22 states and reported that it produced findings comparable to the traditional survey process.
A shorter survey does not mean lower expectations. Surveyors may expand their review when observations, interviews, records, complaints, or resident outcomes raise concerns.
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Facilities must meet a detailed set of performance criteria. Key requirements include:
CMS may also exclude facilities based on certain post-admission schizophrenia diagnoses among long-stay residents.
Based on preliminary June 2026 data, 1,560 of 14,682 nursing homes met the RBS criteria. This represents approximately 12% of facilities nationally.
Appearing on a qualifying facility list does not guarantee that a nursing home will receive an RBS.
Before beginning the survey, the State Survey Agency must confirm that the facility has not developed new risk factors. A facility may be moved back to the traditional survey process because of:
State agencies and CMS may also use the traditional survey process whenever concerns about resident health or safety warrant a more extensive review.
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Beginning September 30, 2026, CMS plans to add an icon to Nursing Home Care Compare profiles for facilities that meet the RBS criteria.
The icon is intended to identify nursing homes that demonstrate higher performance across measures beyond the traditional Five-Star rating. Survey reports and CMS data files will also indicate when an RBS was conducted.
Because eligibility is reviewed regularly, the icon may be removed if a facility no longer meets the criteria.
The new process places even greater importance on sustained performance.
RBS eligibility depends on more than preparing well for one survey. It reflects the facility’s broader compliance and quality systems, including staffing, complaint management, survey history, data accuracy, resident assessments, and clinical outcomes.
Facilities should review:
Even nursing homes that do not currently qualify can use the RBS criteria as a framework for identifying improvement priorities.
Survey readiness should be an ongoing operational practice, not a last-minute response to a survey window.
Qsource works with nursing homes to identify vulnerabilities, strengthen compliance systems, and prepare leaders and staff for the realities of the survey process. Support may include:
Whether a facility qualifies for the new Risk-Based Survey or continues to receive the traditional Long-Term Care Survey Process, the foundation remains the same: reliable systems, accurate documentation, informed staff, and consistent resident-centered care.
Qsource brings more than 50 years of healthcare quality improvement experience to help nursing homes prepare with confidence and address risks before they become citations.
Learn more about Qsource’s nursing home survey readiness and compliance support.
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