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The Centers for Medicare & Medicaid Services (CMS) has launched a new Risk-Based Survey process designed to focus federal nursing home oversight resources on facilities where residents may face greater health and safety risks.
Beginning in September 2026, qualifying nursing homes may receive a streamlined version of the standard recertification survey. CMS also plans to identify qualifying facilities on Medicare’s Nursing Home Care Compare website with a special icon indicating that they meet the agency’s criteria for higher-performing facilities.
For families searching for a nursing home, the new designation may provide another useful piece of information when comparing facilities. However, a “high-performing” designation does not guarantee that a nursing home is safe, adequately staffed or free from abuse and neglect.
Understanding what the designation does and does not mean can help families make more informed decisions about a loved one’s care.
What Is CMS’s New Risk-Based Survey Process?
Nursing homes that participate in Medicare or Medicaid are routinely inspected by state survey agencies as part of the federal oversight system. These surveys evaluate whether facilities comply with requirements intended to protect residents’ health, safety and quality of care.
Under the new Risk-Based Survey process, nursing homes with a history of strong performance may receive a more focused recertification survey that requires less time and fewer survey personnel than the traditional process.
CMS developed the national program after conducting a pilot across 22 states. According to CMS, the goal is to reduce resources spent surveying consistently higher-performing facilities so state agencies can devote more attention to serious complaints and nursing homes where residents may face greater risks.
CMS estimates that approximately 12% of nursing homes nationwide will initially qualify for the Risk-Based Survey process.
How Does a Nursing Home Qualify as “High-Performing”?
To qualify for the Risk-Based Survey process, a nursing home must meet several performance criteria, including:
- A five-star overall facility rating on CMS’s Nursing Home Care Compare
- Accurate submission of required CMS data
- No citations indicating resident harm or substandard quality of care during the applicable survey cycle
- No recent changes in ownership
Compliance with additional CMS eligibility criteria involving staffing, inspection history, data accuracy and other quality measures
Qualifying nursing homes may receive a special icon on Care Compare, allowing families to identify facilities that meet CMS’s criteria for the Risk-Based Survey process.
The designation reflects a nursing home’s documented performance at the time CMS evaluates it. It does not guarantee what an individual resident will experience or that conditions at the facility will remain unchanged.
Will “High-Performing” Nursing Homes Still Be Inspected?
Yes.
The new program does not eliminate federal oversight of qualifying nursing homes. All nursing homes will continue to receive a recertification survey at least once every 15 months.
CMS and state survey agencies may also use the traditional, more comprehensive survey process at an otherwise qualifying nursing home when concerns arise regarding resident health or safety.
The Risk-Based Survey process does not apply to complaint surveys. If surveyors identify concerns about resident safety during a Risk-Based Survey, CMS states that the survey will be expanded.
Residents, family members and employees can therefore continue reporting suspected nursing home abuse and neglect regardless of whether a facility has been identified as higher-performing.
What Does the New CMS Icon Mean for Families?
The new icon indicates that a nursing home satisfied CMS’s eligibility requirements for the Risk-Based Survey process when the agency evaluated the facility.
That may be a positive factor when comparing nursing homes. A qualifying facility has demonstrated strong performance under several CMS measures, including its overall rating and recent survey history.
But families should understand the limits of the designation.
A high-performing designation does not establish that:
- Every resident receives appropriate care
- The nursing home is adequately staffed at all times
- Abuse or neglect has never occurred
- Conditions have remained unchanged since the facility’s last inspection
- The facility can safely meet every resident’s individual medical and personal needs
- Future inspections or complaints will not reveal serious problems
For these reasons, families should consider the designation as one part of a broader evaluation of a nursing home rather than relying on the icon alone.
Why Nursing Home Ratings May Not Tell the Complete Story
CMS ratings, inspection reports and other public information can provide valuable insight into a nursing home’s history. However, these records generally reflect documented conditions during particular reporting periods.
Conditions inside a nursing home can change between inspections. Staffing levels may decline, administrators or clinical leaders may leave, and ownership or operational practices may change. Serious incidents also may not immediately appear in public records, particularly while complaints or investigations are pending.
Most importantly, a nursing home can perform well according to facility-wide measures while still failing an individual resident.
In nursing home neglect cases, the critical questions often involve what happened to a particular person. Did staff follow the resident’s care plan? Did they recognize and respond to changes in the resident’s condition? Were physicians and family members notified when appropriate? Were enough qualified staff available to meet the resident’s individual needs?
A five-star rating or high-performing designation does not excuse failures that result in preventable falls, pressure injuries, medication errors, dehydration or malnutrition, infections or delays in necessary medical treatment.
How Families Can Evaluate a Nursing Home
When choosing a nursing home, families should look beyond the facility’s overall star rating or high-performing designation.
Consider taking the following steps:
- Review recent inspection reports. Look for recurring deficiencies, complaint investigations and citations involving actual harm or immediate jeopardy.
- Examine staffing information. Consider registered nurse coverage, nursing assistant staffing and whether staffing appears adequate during nights and weekends, not only during daytime hours.
- Research ownership and leadership. Recent changes in ownership, administration or clinical leadership may make older ratings less representative of current conditions.
- Visit the facility more than once. Consider visiting at different times of day. An evening or weekend visit may provide a different perspective from a scheduled daytime tour.
- Pay attention to residents and staff. Unanswered call lights, rushed or overwhelmed employees, poor hygiene, strong odors and residents who appear distressed may warrant additional questions.
- Discuss your loved one’s specific care needs. Ask how the facility will prevent falls, manage medications, protect skin integrity, provide adequate nutrition and hydration, and respond to changes in condition.
- Stay involved after admission. Regular visits and communication with nursing staff can help families identify changes or concerns before they become more serious.
What If Neglect Occurs at a Highly Rated Nursing Home?
A five-star rating or CMS high-performing designation does not prevent a resident from experiencing neglect. It also does not prevent a resident or family from reporting unsafe care or pursuing available legal remedies.
When concerns arise, families should document what they observe, preserve relevant communications, seek appropriate medical attention and report urgent safety concerns to the proper authorities.
CMS ratings and inspection histories may provide useful background, but determining whether nursing home neglect occurred often requires a much closer examination of the resident’s medical records, care plans, staffing documentation, facility policies and the nursing home’s response to changes in the resident’s condition.
Speak With a Nursing Home Abuse Attorney
Senior Justice Law Firm represents victims of nursing home abuse and neglect nationwide. Our attorneys investigate cases involving preventable falls, pressure injuries, medication errors, malnutrition, dehydration, infections, delayed medical treatment and other serious failures of care.
Even nursing homes with strong CMS ratings can fail individual residents. If you believe a nursing home failed to protect your loved one, contact our nursing home abuse attorneys for a free consultation.
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