What CMS’s New Risk-Based Nursing Home Surveys Mean for Families (Starting Sept. 2026)

Starting September 8, 2026, the Centers for Medicare & Medicaid Services (CMS) will begin using a new risk-based survey approach for some nursing homes. CMS also plans to add a “high performer” icon on Medicare’s Nursing Home Care Compare to help families spot facilities that qualify for this approach.

Quick takeaway: The icon is a signal, not a guarantee. Nursing homes can still be inspected due to complaints or other health-and-safety concerns—even if they qualify for risk-based surveys.

What CMS’s risk-based nursing home surveys are (plain language)

In the U.S., nursing homes are required to meet federal health and safety standards. CMS oversees this through state survey agencies that conduct inspections (“surveys”) to check compliance.

Under the new approach, CMS will allow higher-performing nursing homes to receive a more focused version of the standard survey process as a way to direct limited survey resources toward where risk of harm may be higher. CMS describes the nationwide start date as September 8, 2026.

What doesn’t change: qualifying homes are still part of ongoing oversight, and complaints or health-and-safety concerns can still lead to additional review using the standard survey approach.

The “high performer” icon on Care Compare: what it’s for

CMS says the high performer icon is meant to help consumers identify nursing homes that qualify for the risk-based survey approach. CMS also describes that qualification is not necessarily permanent—facilities may become ineligible if disqualifying criteria are met after they appear on the qualifying list.

What the icon does NOT mean

Even if you see the icon, it does not mean “extra safe forever.” CMS is explicit that:

Complaint investigations still happen. If concerns are raised, a facility can still be surveyed using the standard survey process.
Health-and-safety triggers still matter. If a problem rises to a level that requires standard survey attention, the risk-based approach does not block that oversight.

Research on complaint investigations and deficiency findings also supports the idea that complaints can provide useful information about quality—one reason families shouldn’t ignore concerns just because a home is otherwise flagged as higher-performing.

Who qualifies (high-level factors families can understand)

CMS describes qualifying using a combination of Care Compare-related performance information and survey/compliance history. The exact qualification and disqualification criteria are detailed in the CMS memo (QSO-26-14-NH), but the reader-friendly framing is:

CMS focuses on higher-performing facilities based on performance signals available through Care Compare
CMS also considers recent compliance/survey indicators and whether certain disqualifying conditions are present

Next step for exact criteria: If you want the precise list of qualifiers and disqualifiers, review CMS’s QSO memo (QSO-26-14-NH).

How to interpret Care Compare as a caregiver

Care Compare already helps families compare nursing homes using multiple types of information (including staffing-related reporting and other quality signals). With the new icon, you’ll have one additional clue—but treat it like a starting point rather than the final decision.

When comparing homes, consider pairing the icon with:

Staffing information and whether the facility can explain how care coverage works across shifts
Other quality and performance details shown on Care Compare
Infection prevention readiness, especially during respiratory illness seasons

Questions to ask on tours and during ongoing care

These questions focus on daily safety concerns older adults and caregivers often raise: staffing coverage, infection prevention, and what happens when concerns come up.

Staffing and day-to-day coverage

“Can you walk me through who will be caring for my loved one during different shifts?”
“If staffing is stretched, what systems are in place to keep scheduled care on track?”
“How do you handle communication between shifts when a resident’s condition changes?”

Infection prevention and outbreak readiness

The CDC’s long-term care respiratory virus guidance can help you ask concrete, practical questions. For example:

“How do you detect respiratory illness early among residents and staff?”
“When should the facility notify the local health department, and who coordinates that?”
“During an outbreak, what changes—such as additional precautions or other measures to reduce spread—do you use?”
“How do you adjust visitor policies during higher-risk periods?”

Escalation pathways (what to do if something feels unsafe)

“If family members have concerns, who do we contact, and how quickly are issues reviewed?”
“How does the facility track problems and confirm corrective actions were completed?”

If you have concerns: practical next steps (don’t wait)

If you notice a pattern that worries you—such as repeated delays in care, infection-control problems, or concerns about staffing coverage—don’t wait for routine survey cycles.

Reasonable steps include:

Speak up promptly to the facility and ask what changes will be made.
Document what you observe (dates, times, who was involved, and what changed afterward).
Escalate through appropriate channels in your area, such as state survey/oversight pathways and advocacy supports. Complaint and concern-based oversight are still part of how nursing home safety is evaluated.

Bottom line

CMS’s risk-based survey approach (starting September 8, 2026) and the Care Compare “high performer” icon are designed to help focus routine oversight for some higher-performing homes. But the icon does not stop complaint investigations or health-and-safety–triggered reviews.

If you’re comparing facilities, use the icon as a helpful signal—then confirm staffing coverage, infection prevention readiness, and how the home responds when concerns are raised.

Key sources

Editorial note: Weence articles are researched from cited public-health, medical, regulatory, journal, and reputable news sources and may be drafted with AI assistance. They are checked for source support, clarity, and safety guardrails before publication.

This article is for general informational purposes only and is not medical advice. Research findings can be early or incomplete, and health guidance can change. Always talk with a qualified healthcare professional about personal symptoms, diagnosis, medications, vaccines, screenings, or treatment decisions. If you think you may have a medical emergency, call emergency services right away.