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Sens. Elizabeth Warren and Mazie Hirono have asked CMS Chief Mehmet Oz to explain the agency’s new Risk-Based Survey program for nursing homes. They argue that shorter inspections, smaller resident samples and eligibility rules may weaken oversight; CMS’s response and the program’s measured outcomes are not included in the report.
Sens. Elizabeth Warren and Mazie Hirono have asked the Centers for Medicare and Medicaid Services to explain its new Risk-Based Survey program for nursing homes, warning that abbreviated inspections could leave residents with less protection from abuse, neglect and poor care. In a letter addressed to CMS Chief Dr. Mehmet Oz, the senators requested information about the program’s standards, facility eligibility and consumer-facing designation.
The senators said the process uses fewer surveyors and smaller resident samples than standard surveys. For facilities with up to 174 residents, CMS requires two surveyors instead of four and an initial sample of six residents, according to the report. Infection control is the only mandatory facility task under the abbreviated process, the letter states.
Warren and Hirono cited National Consumer Voice for Quality Long-Term Care data to argue that eligibility may not reliably identify facilities with consistently strong performance. They said 27 eligible homes had received a resident abuse designation since September 2025, 478 had not had a standard survey in more than a year, and 73 had experienced Medicare or Medicaid payment denials within the previous four years.
The lawmakers also questioned the program’s gold trophy icon on CMS’ Nursing Home Care Compare website, saying consumers could interpret it as proof of superior care despite the facilities receiving less rigorous oversight. They asked how CMS would respond if participating homes failed program requirements and how the agency would prevent the designation from misleading the public.
Survey Changes Could Affect Resident Oversight
The dispute concerns how federal inspectors evaluate nursing homes and how families interpret information about facility quality. If inspections cover fewer residents or fewer areas, the senators argue, problems could be harder to detect during a survey. Their letter says the change could affect an estimated 114,300 residents, citing Consumer Voice data; that is the lawmakers’ cited estimate, not an independently established count of people harmed by the program.
The designation also has potential consequences for consumers comparing facilities. A prominent mark on a federal comparison site may influence choices, while its meaning could be misunderstood if it signals eligibility for a different survey process rather than a comprehensive assessment of care. CMS’s explanation of the icon and the program’s results will help clarify what the designation says—and what it does not say.
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How the Risk-Based Survey Differs
CMS’s new approach changes the staffing and scope of surveys for eligible nursing homes. Under the example described in the letter, facilities with up to 174 residents receive two surveyors and an initial sample of six residents, compared with four surveyors under the standard process. The letter says infection control is the sole mandatory facility task in the abbreviated survey.
The senators also questioned how CMS selects facilities. They said about half of homes newly eligible would not have qualified a year earlier, and argued that prior performance does not guarantee continued quality. They further criticized eligibility criteria for not taking account of facility finances and ownership structures, citing concerns about private equity ownership and resident outcomes. Those points are the lawmakers’ criticisms; the report does not provide CMS’s response or a comparative evaluation of the program.
“Nursing home residents depend on comprehensive, thorough, and unannounced surveys to detect, correct, and prevent abuse, neglect, and substandard care.”
— Sens. Elizabeth Warren and Mazie Hirono, in their letter to CMS Chief Mehmet Oz
CMS Results and Legal Questions Remain Open
The report does not include a response from CMS, agency data comparing outcomes under the Risk-Based Survey process with standard surveys, or a determination that the program violates federal law. The senators raised the statutory question but did not establish a legal finding in the cited material.
It is also unclear how CMS measures the program’s effectiveness, how often it monitors participating facilities, what conditions would lead to suspension, or how it would report comparative outcomes publicly. The senators’ cited figures describe facility histories and eligibility concerns; they do not, on their own, show that abbreviated surveys caused resident harm.
CMS Reply Requested by November 9
Warren and Hirono requested that Oz answer their questions by Nov. 9, 2026. They asked CMS to address the program’s effectiveness, monitoring and suspension criteria, comparative public reporting, responses to facilities that fail requirements, and safeguards against consumers misreading the trophy designation.
The next clear development will be whether CMS responds by the requested date and what information it provides. Until the agency’s reply or further program data are available, the concerns described in the letter remain the senators’ claims rather than a settled assessment of the program’s performance.
Key Questions
What is CMS’ Risk-Based Survey program?
It is a nursing home survey process that uses a reduced inspection approach for eligible facilities. The lawmakers’ letter says infection control is the only mandatory facility task under the abbreviated process.
What changes to survey staffing did the senators cite?
For facilities with up to 174 residents, the report says CMS requires two surveyors instead of four and an initial sample of six residents.
What do the senators want CMS to explain?
They requested information on program effectiveness, eligibility, monitoring, suspension criteria, public comparisons of outcomes, responses to noncompliant facilities and the trophy icon’s meaning to consumers.
Has CMS responded to the letter?
The source report does not provide a CMS response. The senators requested answers from CMS Chief Mehmet Oz by Nov. 9, 2026.
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