CMS Announces Nationwide Expansion of Risk-Based Surveys

• By: Maureen Carland
• On: 07/27/2026 07:45:10
• In: Quality/Regulatory

CMS has released long-awaited guidance implementing the Nursing Home Risk-Based Survey (RBS) process nationwide, effective September 8, 2026.
Expanding RBS was one of AHCA's key recommendations under its Better Way agenda, and today's announcement — driven by AHCA advocacy led by Maine's own Holly Harmon — is expected to ease staff burden, reduce survey backlog, and reward high-quality care.

Building on a pilot conducted across 22 states since 2023, RBS directs limited state survey resources away from consistently high-performing facilities so states can focus on higher-risk providers. Qualifying facilities will still be surveyed at least every 15 months, and states retain the ability to conduct a traditional survey at any RBS-qualifying facility if concerns arise (e.g., complaints). About 12% of nursing facilities nationwide are expected to qualify initially.

To qualify, a facility must meet several criteria each quarter, including a 5-star overall rating, a 3-star (or better) staffing rating, no citations for Actual Harm, Immediate Jeopardy, or Substandard Quality of Care in the last survey cycle, a standard survey within the last 18 months, no active staffing waivers, passing PBJ and MDS audits, a Health Inspection Score at or below the state's 50th percentile, no unexplained new schizophrenia diagnoses in residents 65+, and no recent change of ownership. Special Focus Facility candidates are also excluded.

Beginning September 30, 2026, CMS will publish a quarterly list of RBS-qualified facilities on its Provider Data Catalog, and qualifying facilities will display a gold trophy icon on the Care Compare tool at Medicare.gov. State agencies will receive quarterly qualification lists from CMS ahead of each cycle.

See QSO-26-14-NH and the announcement from CMS for more information.

Staff contact: mcarland[at]mehca.org