Care Compare's New High Performing Icon and the Risk-Based Survey

Families comparing nursing homes on Medicare's Care Compare website may now see a small trophy next to some facilities' star ratings. CMS scheduled the "High Performing Facility" icon to begin appearing on October 8, 2026. It marks nursing homes that qualify for CMS's new Risk-Based Survey, a shorter version of the standard inspection.

Both changes come from CMS memo QSO-26-14-NH, first released July 16, 2026 and revised September 29, 2026. The revision pushed the icon's start back about one week, to October 8. CMS estimates that only about 12% of nursing homes qualify at the start.

What the Risk-Based Survey Is

The Risk-Based Survey (RBS) is a modified version of the standard Long-Term Care Survey Process. CMS launched it nationwide beginning September 8, 2026, following state survey schedules, after a pilot that began in 2023 in 22 states.

According to the memo, the RBS still reviews all required areas but uses fewer survey activities and a smaller resident sample. CMS says these surveys take roughly half the time with fewer surveyors. In its July press release, CMS said the goal is to let state agencies focus limited resources on facilities where resident health and safety are at greater risk.

A few points are easy to miss:

• It is not an exemption. Qualifying facilities still get a standard recertification survey at least once every 15 months.
• It can switch back. State agencies can use the traditional survey at any qualifying facility when health and safety concerns arise, such as complaints.
• The standard does not change. Hall Render notes that the pilot found noncompliance and resident risk at rates similar to the traditional process.

Who Qualifies

Eligibility is strict. The memo lists conditions that disqualify a facility. To qualify, a nursing home must not have any of the following:

• An overall Five-Star rating below 5 stars
• A staffing rating below 3 stars
• Any citation for Actual Harm, Immediate Jeopardy or Substandard Quality of Care in the last survey cycle
• More than 18 months without a standard survey
• Any staffing waiver in effect
• A failed Payroll-Based Journal (PBJ) staffing data audit or a failed MDS audit
• A health inspection score above the 50th percentile in the state (where a higher score means more deficiencies)
• Two or more residents age 65 or older coded with schizophrenia after admission who did not have that diagnosis when admitted
• A change in ownership since the last standard survey
• Status as a Special Focus Facility candidate

CMS sends qualifying lists to state agencies every quarter, in March, June, September and December. A facility generally stays eligible for six months after the state receives the list, unless something disqualifies it in the meantime.

Even a listed facility can be moved back to a standard survey. Before an RBS begins, a new harm, Immediate Jeopardy, abuse or Substandard Quality of Care citation from a complaint investigation, a pending Immediate Jeopardy complaint, more than three pending medium-or-higher complaints, a nursing waiver or an ownership change means the state must use the standard process.

What the Icon Means for Families and Referrals

The icon sits next to a facility's star rating. CMS says it will stay on the profile only while the facility remains eligible. AHCA/NCAL describes these facilities, based on CMS's Five-Star technical guide, as having fewer deficiency citations, higher staffing and strong results on other quality indicators.

The icon is not just about survey workload. Hospital case managers, families and payers already use Care Compare when choosing a facility, and a visible marker of high performance may matter in those conversations. Losing the icon at the next quarterly update can matter too.

The memo also notes that states should rely on the lists CMS sends them, not on what the website shows, because of data processing differences. If your facility's status looks wrong online, check with your state agency or corporate compliance team.

Quick Checklist

These steps help leaders see where they stand, whether or not the building qualifies today.

• Check your current status. Look up your facility on Care Compare and compare your overall, staffing and health inspection ratings against the criteria above.
• Protect data accuracy. A failed PBJ or MDS audit disqualifies a facility. Review how staffing hours and MDS assessments are checked before submission.
• Review diagnosis coding. Confirm that new psychiatric diagnoses after admission are supported in the record, consistent with your medical director's guidance.
• Track complaints closely. Pending complaint investigations can move a survey back to the standard process. Bring complaint trends to QAPI.
• Know your next quarterly window. Eligibility is rechecked every quarter, so treat it as an ongoing measure, not a one-time award.

Strong quality results are built on catching resident changes early, and a daily admission risk screen, like the one Keystone builds from PointClickCare data, is one tool teams use to support that work.

This article is general education for skilled nursing teams. Follow your facility's policies and the direction of your medical director and providers.