CMS High Performing Nursing Homes

A mark CMS added to Nursing Home Care Compare on October 8, 2026. It identifies nursing homes that qualify for CMS's new Risk-Based Survey, a shorter version of the standard inspection with a smaller survey team and about half the time on site. CMS describes it as identifying homes with a higher level of performance in addition to the five-star rating.

1,712 of 14,685 nursing homes, or 11.7%, in the October 2026 release. California has the most at 151; among states with at least 20 nursing homes, Nevada has the highest share at 24%, then Washington and Minnesota at 20%. Alabama has 2 of its 224.

CMS's memo QSO-26-14-NH lists eleven requirements. A home needs a 5-star overall rating and at least 3 stars for staffing, no citations for actual harm, immediate jeopardy or substandard quality of care in its last survey cycle, a standard survey within the last 18 months, and a health inspection score in the better half of its state. It must also have no staffing waiver, pass CMS's staffing-data and resident-assessment audits, have no ownership change since its last survey, not be a Special Focus Facility candidate, and not have two or more residents aged 65 and over newly coded with schizophrenia after admission.

No. 3,154 nursing homes have a 5-star overall rating, and 1,712 of them carry the icon. CMS says the most common reason a 5-star home misses out is a staffing rating below 3 stars.

527 homes meet every requirement that can be checked from public data and still do not carry the icon. CMS also checks staffing waivers, its staffing-data and resident-assessment audits and new schizophrenia coding, and publishes none of those results per home, so the map marks these homes as left off for a non-public check.

CMS sends the list of qualifying homes to state survey agencies every quarter and publishes the icon in its monthly Provider Information file. The first refresh came in the October 2026 file: 262 homes came on and 249 came off, most of them after a drop in their overall, staffing or quality measure rating. Move the slider on the map to see both lists. This page is refreshed with each monthly release.

CMS started Risk-Based Surveys nationally on September 8, 2026. Its October 2026 file has the first 11: 9 found no citations, and the worst finding was an E. CMS also labels 127 surveys from the pilot it ran from April 2024, mostly in Ohio, Wisconsin, Minnesota and Pennsylvania; 39% of those found no citations and 8 found harm or worse. Pilot homes were not chosen from the High Performing list, so the map shows the national surveys and adds the pilot only if you tick it. The survey is shorter by design, so fewer citations are expected.

For a nursing home, qualifying means a shorter standard inspection and a visible mark on the page families and hospital discharge planners use to compare homes. For anyone studying a market, it shows where the homes CMS considers its strongest performers are, and how many sit near a given facility.