WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services will shorten routine inspections for roughly 12% of U.S. nursing homes beginning in September, redirecting limited state oversight resources toward facilities where residents face greater health and safety risks.
The risk-based survey process will apply initially to nursing homes meeting CMS standards for high performance, including a five-star overall rating, accurate federal data submissions and no recent citations involving resident harm or substandard care.
Qualified facilities must also have had no recent ownership changes. CMS will reassess eligibility quarterly and identify qualifying nursing homes with an icon on the Care Compare tool at Medicare.gov.
The policy is intended to reduce the time and staffing required for standard recertification surveys at top-rated facilities, allowing state agencies to devote more resources to serious complaints and lower-performing homes without additional federal funding.
Congressional funding for annual nursing home surveys has remained flat since 2015, according to CMS.
All nursing homes will continue to receive an inspection at least once every 15 months. State agencies and CMS may also conduct a traditional long-term care survey at any qualifying facility when complaints or other information raise concerns about resident safety.
“Nursing homes care for our seniors, and that care should be of the utmost quality,” CMS Administrator Dr. Mehmet Oz stated. “At CMS, we are continually looking for ways to recognize excellence for top performers and to encourage lower performers to improve.”
CMS developed the national program after testing the approach in 22 states. The agency reported that the pilot reduced the resources needed to inspect higher-performing facilities, though it did not provide specific figures on inspection time, staffing reductions or enforcement outcomes.
Staffing ratings are among the criteria used to determine eligibility, creating a financial and regulatory incentive for facilities to maintain staffing levels sufficient to preserve their five-star status and qualify for the streamlined review.
The agency plans to train state survey personnel before implementation begins in September 2026. High-performing facility designations are expected to appear on Care Compare during the same month.
The CMS policy memorandum is available at https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-cms-locations/nursing-home-risk-based-survey-national-implementation.
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