July 21, 2026
The Centers for Medicare & Medicaid Services (CMS) issued QSO-26-14-NH last week, directing state survey agencies to begin using the Risk-Based Survey (RBS) at qualifying nursing homes starting September 8, 2026.
The RBS is a modified version of the Long-Term Care Survey Process (LTCSCP) used for standard recertification surveys. It reviews all required areas with fewer activities, uses a smaller resident sample, and is conducted in roughly half the time with fewer surveyors. All facilities remain subject to a standard survey at least every 15 months.
To qualify, a facility must have a 5-star overall rating; a staffing rating of at least 3 stars; a health inspection score at or below the state 50th percentile; no actual harm, immediate jeopardy, or substandard quality of care citations in the last survey cycle; a standard survey within 18 months; no staffing waiver; no failed PBJ or MDS audits; no change in ownership since the last standard survey; no Special Focus Facility candidate status; and fewer than two residents 65 or older coded with schizophrenia after admission without that diagnosis.
CMS will send each state agency a list of qualified facilities at the end of each quarter. Facilities stay eligible for six months unless they trigger a disqualifying criterion. States may use the traditional LTCSP at any RBS-qualifying facility based on health and safety concerns, and CMS may require it.
CMS will also place an icon on the Nursing Home Compare profile pages of qualifying facilities. The qualifying list will be posted to Care Compare and the Provider Data Catalog beginning September 30, 2026. CMS notes that the state lists and the Care Compare icon will not always match, and states must survey based on the lists sent to them.
CMS says the RBS was tested in 22 states and over 100 facilities beginning in 2023, with findings comparable to the traditional process, and that the survey budget has not increased since 2015, while complaint survey obligations have risen more than 20 percent, increasing the need for these types of surveys.