CMS Risk-Based Surveys: The 11 Disqualifiers and What They Mean for the Other 88%

September 8, 2026 was the nationwide launch date for risk-based surveys under CMS memo QSO-26-14-NH, with state survey agencies starting on their own schedules from that date. CMS estimates that roughly 12% of nursing homes qualify. Those facilities get a shorter recertification survey, a smaller survey team, a smaller resident sample, and an icon on their Care Compare profile.

Most of what has been written about the risk-based survey explains what it is. This article is for the other 88%. The eleven eligibility criteria in the memo are, read from the other direction, a list of the things CMS has decided make a facility worth a full look. That makes them a useful self-audit whether or not the icon is a realistic goal for your building, because most of them describe something a surveyor, a referral source, or a family already sees.

I will take the memo's criteria in the order that matters operationally: what you cannot change this quarter, what your citation history has already decided, and what a Director of Nursing or administrator can actually move before the next quarterly list is cut.

What Actually Changed on September 8

The risk-based survey, or RBS, is not a new survey type. The memo describes it as "a modified form of the LTCSP used for standard recertification surveys," with "a streamlined review of all the required areas and fewer activities." CMS says RBS surveys "are conducted in roughly half the time with fewer total surveyors as the standard LTCSP," and that "the RBS includes a smaller number of residents to review as compared to the traditional survey process."

Three things did not change. State agencies are still "required to conduct a standard recertification survey of nursing homes at least once every 15 months." The compliance bar is the same, because every required area is still reviewed. And the state can decide to run a full survey instead: state agencies "may opt to conduct a standard survey using the LTCSP (i.e., non-RBS process) in any RBS-qualifying facility, based on concerns related to residents' health and safety, such as complaint reports," and CMS "may also require" it.

Two things are new for the public. CMS "will place an icon on each nursing home's profile page on the Nursing Home Care Compare website to identify facilities that qualify for the RBS," and the icon "will remain on the nursing home's profile page until the facility is no longer eligible." Separately, anyone reading survey results will be able to tell an RBS from a full survey "through a footnote on the webpage that includes survey results, through an indicator in the actual survey report (form CMS-2567), and in the relevant survey files posted in CMS' Provider Data Catalog."

That last detail is easy to skip past. It means a referral coordinator at a hospital, or a plaintiff's attorney, can now see at a glance whether your last survey was the abbreviated one or the full one.

The Eleven Disqualifiers, Read as a Self-Audit

The memo lists eleven conditions, any one of which removes a facility from the quarterly qualifying list. Quoted from QSO-26-14-NH, a facility does not qualify if it has:

1. "Less than a 5-Star Overall Rating"
2. "Less than 3-star Staffing Rating"
3. "Any citation(s) for Actual Harm, or Immediate Jeopardy (IJ) or Substandard Quality of Care (SQC) in the last survey cycle"
4. "More than 18 months without a standard survey"
5. "Any staffing waivers in effect"
6. "Failed Payroll-Based Journal (PBJ) staffing data audit"
7. "Failed resident assessment Minimum Data Set audit (MDS)"
8. "Health Inspection Score higher than the 50th percentile in the state"
9. "Two or more residents aged 65 or older that are coded with diagnosis of schizophrenia after being admitted without this diagnosis"
10. "A change in ownership since the last standard survey"
11. "Special Focused Facility Candidate"

CMS provides the list to state agencies "at the end of each calendar year quarter (March, June, September, and December)." Then, before an RBS is actually scheduled, the state agency runs a second check. Per the memo, the SA "must ensure that a facility does not meet any of the RBS disqualifying criteria," which at that stage include citations "at Actual Harm, Immediate Jeopardy, abuse (at any level), or Substandard Quality of Care that occurred on an intake investigation while the facility was listed as qualified for the RBS," any "Pending Intake Investigations triaged at Immediate Jeopardy," "More than three (3) pending non-IJ active intakes" triaged at medium or higher, CMS-approved nursing waivers, and a change in ownership since the last standard survey.

Note the phrase "abuse (at any level)." A D-level abuse citation off a complaint investigation, arriving while the facility is on the qualifying list, is enough to lose the RBS at the scheduling stage, even though it would not have disqualified on the quarterly list itself.

Grouped by what you can do about them, the eleven sort into four buckets.

Bucket one: outcomes of the last two years

The overall star rating (1), the health inspection score (8), survey recency (4), an ownership change (10), and Special Focus Facility candidacy (11) are all products of history. No policy revision, hire, or in-service changes them in a quarter. If you are in this bucket on one of these, the honest timeline to the icon is measured in survey cycles, not months. The value of the self-audit is knowing that, so nobody in the building is chasing a target that the calendar has already ruled out.

Bucket two: citation history

Criterion 3 is a flat disqualifier. One G-level citation in the last survey cycle, one IJ, one finding at a scope and severity that meets the definition of substandard quality of care, and the facility is out regardless of every other number. There is no offset for a five-star staffing rating or a spotless MDS audit.

This is also the criterion most directly connected to work your team already does. The citation is the outcome; the Plan of Correction is the process that determines whether it recurs and whether the revisit clears. More on that below.

Bucket three: data integrity

The PBJ audit (6), the MDS audit (7), and the schizophrenia coding criterion (9) are the three a DON and administrator can move fastest, because each one is a documentation practice rather than a care outcome.

The schizophrenia criterion deserves a plain reading. CMS is looking for residents 65 and older who were admitted without a schizophrenia diagnosis and now carry one on the MDS. The concern is antipsychotic quality measure exclusion. If your building has two or more such residents, the question to ask is not "how do we code differently" but "does the clinical record support that diagnosis, and who made it." An audit of every resident currently coded with schizophrenia against the admission record, the diagnosing practitioner, and the supporting documentation is a one-week project with a clear deliverable.

PBJ and MDS audits are pass-fail. Your PBJ submission should reconcile to payroll and to the nurse staffing posting for the same days. Your MDS accuracy should be checked against the clinical record on a sample before every submission, not after a CMS audit letter arrives. Both are QAPI projects with a defined method and a measurable result, which is the kind of thing a surveyor asks about under F865 whether or not RBS is in play.

Bucket four: staffing

The 3-star staffing rating (2) and staffing waivers (5) sit between the buckets. Waivers are a decision you can reverse, at a cost. The staffing rating is a function of PBJ-reported hours and turnover against case mix, so it moves with real staffing changes and with the accuracy of what you report, which loops back to bucket three.

The Health Inspection Score Is the One a Plan of Correction Touches Directly

Criterion 8 is the one worth understanding in detail, because it is the one a Plan of Correction touches directly.

The health inspection score is not a star rating. It is a raw point total, and lower is better. Per the July 2026 Five-Star Technical Users' Guide, the score is built from "the two most recent recertification surveys for each nursing home, complaint deficiencies during the most recent three-year period, deficiencies cited on focused infection control surveys in the most recent three-year period," plus revisit points.

The weighting is what matters. "The most recent standard survey (rating cycle 1) is assigned a weighting factor of 3/4, and the second most recent standard survey (rating cycle 2) is assigned a weighted factor of 1/4." Complaint and infection control deficiencies "within the most recent 12 months" carry the same 3/4 weight; "those from 13-36 months ago have a weighting factor of 1/4."

So your last standard survey enters the score at 3/4 weight. Whatever happened on it, the RBS list will keep reading it for the next cycle at 3/4 weight, and for the cycle after that at 1/4 weight.

The points per deficiency, from the same guide:

Substandard quality of care findings carry higher values at F, H, I, J, K, and L. Ten D-level tags on a standard survey cost 40 points. One G costs 20. One J costs 50 and, under criterion 3, ends the RBS conversation for the cycle on its own.

Then there are revisits. "No points are assigned for the first revisit; points are assigned only for the second, third, and fourth revisits and are proportional to the health inspection score for the survey cycle." The guide's Table 2 sets the second revisit at 50% of the cycle's score, the third at 70%, and the fourth at 85%.

Read that again from the DON's chair. A survey that produces 60 points and clears on the first revisit stays at 60. The same survey, where the Plan of Correction does not hold and the state comes back a second time, becomes 90. The deficiencies did not get worse. The correction did not stick, and CMS charges for that separately.

Criterion 8 then compares the result to every other facility in your state: you need to be at or below the 50th percentile. The bar is relative, which means it moves with your neighbors, and it means the facilities that qualify in a state with a tough survey agency are not necessarily better than the ones that miss in a state with an easy one.

Why Your Last Plan of Correction Now Has a Longer Tail

Before September 8, a weak Plan of Correction cost you a revisit and some points. Now the same document has three additional consequences.

First, if the underlying citation was at harm level or above, criterion 3 removes the facility from the RBS list for the survey cycle, full stop. The quality of the POC does not change that, but it does determine whether the same tag reappears next cycle and resets the clock.

Second, a POC that clears on the first revisit costs nothing extra. One that does not clear costs half the cycle's score again, at 3/4 weight, against a 50th-percentile line. The difference between a POC that holds and one that does not is now visible on a public icon.

Third, the complaint window is three years. A complaint survey in the next 36 months that produces a citation adds to the score, and if it produces a harm, abuse, or SQC finding while the facility is on the qualifying list, it disqualifies at the state agency check. Complaint investigations start with intakes, and intakes start with grievances that did not resolve inside the building. The grievance process required at §483.10(j) is now, indirectly, an RBS eligibility control.

What a Plan of Correction has to do has not changed. It still has to correct the cited residents, identify others at risk, fix the system that produced the deficiency, and monitor with a named person and a stated frequency until QAPI closes it. What changed is the cost of a POC that reads well and does not hold. For a walkthrough of the structure, see our guide on what a Plan of Correction is and how to respond to Form 2567.

A 15-Month Plan for the 88%

The quarterly list is the natural cadence. Here is what I would put on it.

This quarter: data integrity. Audit every resident coded with a schizophrenia diagnosis against the admission record and the diagnosing practitioner. Reconcile the last two PBJ submissions to payroll and to the daily staffing posting. Pull a sample of recent MDS assessments and check each coded item against the clinical record. All three produce a written finding and a fix, which is the shape of a QAPI project.

Next quarter: your own last survey. Take your most recent Form 2567 and audit the building against every tag on it, as if the revisit were tomorrow. Not the POC, the practice. Then take the state's most frequently cited tags and do the same. The F-Tag reference pages on this site cover what surveyors look for under each of the most cited tags. A 30-day version of this exercise is laid out in our survey preparation checklist.

The quarter after: staffing and complaints. Look at the staffing rating with the PBJ reconciliation in hand, because reported hours are what the rating sees. Then look at the grievance log. Every grievance that left the building and became an intake is a data point on how the process is working. If more than three non-IJ intakes triaged at medium or higher are pending when the state goes to schedule, you are disqualified at that step, whatever the quarterly list said.

Every quarter: abuse reporting. Because a single abuse citation at any severity disqualifies at the state agency check, the reporting and investigation process under F609 is now on the list. Timely reporting, a complete investigation file, and a finding that stands up are the three things that keep an allegation from becoming a citation.

None of this is new work. All of it is work that, in my experience, gets done inconsistently, and the RBS list is a reason to do it on a schedule.

What Not to Do

Do not build a program around the icon. The icon is the byproduct of a facility that does not produce harm citations, submits accurate data, and staffs at a level the rating recognizes. A program that targets the icon directly will make choices, on coding especially, that the ninth criterion exists to catch.

Do not read "half the time" as "half the scrutiny." The memo is explicit that all required areas are still reviewed, and the state agency can choose a full LTCSP survey for any qualifying facility on health and safety concerns. A facility that treats the RBS as a lighter survey is betting that nothing in the building draws that concern.

Do not assume the list is stable. Eligibility is recalculated every quarter and can be lost at the scheduling step on a single intake. A facility that qualifies in September and takes a harm citation off a complaint in November is off the list before the state ever schedules the RBS.

Bringing It Together

The risk-based survey is a sorting mechanism, and for most facilities the immediate effect is not a shorter survey. It is that the criteria CMS uses to sort are now written down in one place, in eleven lines, with a public marker attached.

For the 88%, the practical response is to treat the eleven criteria as an audit schedule. Three of them are documentation practices you can fix this quarter. One of them is the quality of your last Plan of Correction, which decides whether your revisit clears and whether the same tag comes back. The rest are the accumulated result of the last two survey cycles, and the only way through them is to make the next one clean.

Paul Richards, RN, MSHI

Founder, EasyPOC

Paul Richards is a registered nurse and health informatics professional with years of experience in skilled nursing facility compliance and quality improvement. He built EasyPOC to solve the compliance documentation challenges he witnessed firsthand every day.