CMS Could Improve Oversight of States' Use of Contract Surveyors for Nursing Home Surveys

CMS did not provide adequate oversight of States’ use of contract surveyors to conduct nursing home surveys.

During our audit period, CMS issued a memo to SAs outlining contracting practices SAs could use to ensure that contract surveyors meet Federal requirements, but CMS did not monitor whether SAs implemented practices that achieved the memo’s underlying objectives.

Our survey of 14 States that used contract surveyors found that all 14 could have improved their policies and procedures to ensure that the CMS guidelines were met.

In the absence of CMS monitoring and oversight, there is an increased risk that SAs have not implemented sufficient controls to ensure that contract surveyors meet Federal requirements when performing nursing home surveys.

Add worker classification (i.e., employee or contract surveyor) as a required entry in CMS's quality improvement and evaluation system (iQIES) and require CMS and SAs to record the status of each individual performing any nursing home survey (including an FMS).

Confirm that SAs have policies and procedures in place to ensure that contract surveyors performing nursing home surveys meet Federal requirements; CMS could verify these policies and procedures during its annual assessment of SAs.