Today, the Centers for Medicare and Medicaid Services (CMS) released guidance on the Nursing Home Risk-Based Survey (RBS) National Implementation. This is an expansion of the RBS pilot program that CMS began in 2023.
The RBS program aims to improve the effectiveness and efficiency of nursing home oversight to protect residents' health and safety. CMS also notes that the RBS will allow the agency to focus less survey resources on facilities that continue to excel at providing quality care.
CMS plans to implement the nationwide RBS on September 8, 2026.
How It Will Work
The program is designed to encourage facilities to improve the quality of care they provide to qualify for the RBS. Only high-performing facilities will be able to participate. About 12% of all nursing facilities nationwide will qualify for the new RBS survey process.
Today's QSO memo provides the current number and percentage of nursing facilities that qualify under the current RBS criteria in each state, along with the number of facilities that do not qualify and the reasons for their exclusion.
At the end of each quarter, CMS plans to provide State Agencies with a list of RBS-qualified facilities. The list of qualifying nursing homes, each quarter, will be made publicly available on CMS's Provider Data Catalog and the Nursing Home Care Compare website beginning September 30, 2026.
To identify the higher-performing facilities that qualify for the RBS, CMS will include an icon of a gold trophy on the facility's Care Compare site to recognize such facilities.
Examples of reasons why a facility would not qualify for an RBS include:
- Less than a 5-Star Overall Rating
- Less than 3-star Staffing Rating
- Any citation(s) for Actual Harm, or Immediate Jeopardy (IJ), or Substandard Quality of Care (SQC) in the last survey cycle (the last standard survey and any complaint investigations in the last year)
- More than 18 months without a standard survey
- Any staffing waivers in effect
- Failed Payroll-Based Journal (PBJ) staffing data audit
- Failed resident assessment Minimum Data Set audit (MDS)
- Health Inspection Score higher than the 50th percentile in the state (lower scores indicate better performance)
- Two or more residents aged 65 or older who are coded with a diagnosis of schizophrenia after being admitted without this diagnosis
- A change in ownership since the last standard survey
- Special Focused Facility Candidate
See QSO-26-14-NH and the announcement from CMS for more information.
What Comes Next
The AHCA Regulatory team will continue to review the memo and will review any additional materials CMS releases before the national implementation date on September 8. More information on webinars and additional member materials will be made available soon.
Please reach out to regulatory@ahca.org with any questions.