In March 2026, Mass Senior Care reported on the Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards and Quality’s (CCSQ) release of Optimal Health for All Within Nation’s Health and Long-Term Care Systems: CCSQ FY2025–2028 Strategic Roadmap. The roadmap identified several initiatives aimed at reducing survey and certification burden, including waiver demonstrations, risk-based nursing home surveys, and evaluations of Accreditation Organization processes.
Today, CMS released QSO-26-14-NH Nursing Home Risk-Based Survey National Implementation. The memorandum outlines the new Risk-Based Survey (RBS) process and directs state survey agencies to focus fewer survey resources on higher-performing nursing facilities, allowing states to devote greater attention to facilities where residents may face increased health and safety risks.
Building on a pilot program conducted in 22 states, including Massachusetts, the RBS model is intended to improve the efficiency and effectiveness of nursing facility oversight. For facilities that consistently demonstrate strong performance, the RBS process will reduce both the time and staffing resources required to conduct standard recertification surveys. To qualify for a risk-based survey, a nursing facility must meet several stringent criteria each quarter. These include maintaining a five-star overall rating on CMS’s Care Compare website, submitting accurate and timely data to CMS, having no citations for actual harm or substandard quality of care during the previous survey cycle, and experiencing no recent ownership changes. Based on current data, 35 Massachusetts nursing facilities (10.26%) qualify for participation in the RBS process.
Qualified facilities will be identified on the website at Care Compare website. Following training for state survey agency staff, CMS plans to begin national implementation of the RBS program in September 2026. The designation of qualifying high-performing facilities is also expected to appear on Care Compare beginning in September 2026.
Resources:
The Survey Resource Folder will be updated to include comprehensive information on both the Long-Term Care Survey Process (LTCSP) and the Risk-Based Survey (RBS) program. Resources will include survey procedures, required standards and protocols, assessment tools, and compliance checklists used by surveyors to evaluate performance and document findings.