CMS Adopts Risk-Based Approach for Nursing Home Oversight Starting September 2026

The Centers for Medicare & Medicaid Services (CMS) is set to launch a transformative risk-based survey (RBS) approach for nursing home oversight, beginning September 2026. This initiative represents a significant shift in how oversight is conducted in the nursing home sector, particularly as it repositions resources to focus on lower-performing facilities. This move comes in light of a necessity to enhance quality care for residents while balancing budgetary constraints that have remained static since 2015.

The RBS initiative is built upon findings from a successful pilot program implemented across 22 states. The program has demonstrated the potential for more efficient oversight by reducing the amount of time and staff required for standard recertification surveys at higher-performing nursing homes. Under the new paradigm, state agencies are empowered to direct more attention and resources toward facilities where residents’ health and safety may be at greater risk. A notable aspect of this strategy is the incentivization of quality improvements among nursing homes, which CMS hopes to promote through its updated Care Compare tool on Medicare.gov. By granting a distinct icon for higher-performing facilities, CMS aims to drive consumer awareness and preference for quality care providers.

The implications for procurement professionals are substantial. As CMS implements its new survey process, state agencies and any contractors involved in the nursing home sector will need to acclimate to the changes in survey frequency and focus. The likelihood is high that requirements for survey tools and services will shift to align with these newly adopted risk-based methodologies. Vendors specializing in healthcare quality assessment and compliance solutions may find growing opportunities as states adapt to this new framework.

Moreover, enhancements to the Care Compare tool are expected to create a greater demand for data management, analytics, and IT services that support effective quality reporting. CMS's emphasis on transparency not only enhances consumer access to facility ratings but should also encourage nursing homes to prioritize improvements in staffing and care quality. By making it more difficult for lower-performing facilities to remain operational without serious enhancements, CMS’s RBS model underscores its commitment to elevating standards across the board.

“Strengthening oversight of long-term care facilities is one of many top priorities at CMS,” remarked CMS Administrator Dr. Mehmet Oz. This new strategy brings with it the potential for institutional reform, improving not only the safety and quality of care for elderly residents but also fostering a more competitive environment among nursing homes to meet the stringent RBS qualifications.

As 12% of all nursing facilities are projected to qualify for the RBS criteria initially, understanding these thresholds and their implications for operational planning will be crucial for stakeholders within the procurement landscape. Facilities will be subjected to rigorous quarterly assessments, which will evaluate their overall star ratings and other performance metrics that indicate the level of care provided. By addressing these dynamics, both state agencies and vendors can better navigate the evolving landscape of healthcare procurement initiated by CMS's innovative approach.