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.

1,699 of 14,689 nursing homes, or 11.6%, in the October 2026 release. California has the most at 159; among states with at least 20 nursing homes, Nevada has the highest share at 23%, then Minnesota at 20% and Iowa at 19%. Alabama has none 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. 3,011 nursing homes have a 5-star overall rating, and 1,699 of them carry the icon. CMS says the most common reason a 5-star home misses out is a staffing rating below 3 stars.

For two reasons. CMS built its list from the July 29, 2026 star ratings, so 131 homes that now have 5 stars overall and at least 3 for staffing, and meet every other public requirement, were rated lower in July; the map shows both ratings, as in 5 stars now and 4 in July. Another 310 homes meet every requirement that can be checked from public data. 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. A home keeps the icon until it no longer qualifies. This page is on the October 2026 release and is refreshed with each monthly release.

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.