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States' Backlogs of Standard Surveys of Nursing Homes Grew Substantially During the COVID-19 Pandemic


State Survey agencies (States), on behalf of the CMS, are required conduct standard surveys of Medicare/Medicaid-certified nursing homes at least every 15 months to ensure that they meet Federal requirements. Standard surveys are comprehensive onsite inspections that evaluate the safety and quality of care provided by nursing homes. In March 2020, to protect public health and address other concerns associated with the Public Health Emergency, CMS suspended standard surveys in nursing homes to reduce surveyor time on site.

Our December 2020 report, Onsite Surveys of Nursing Homes during the COVID-19 Pandemic: March 23 - May 30, 2020, found that States faced backlogs of standard surveys of nursing homes early in the COVID-19 pandemic, with 8 percent of nursing homes having gone at least 16 months without a standard survey as of June 2020. CMS authorized States to resume standard surveys in August 2020 "as soon as they have the resources (e.g., staff and/or Personal Protective Equipment) to do so." This Addendum updates the extent to which States face backlogs of standard surveys of nursing homes.


We analyzed CMS administrative data on standard surveys that States conducted from February 1, 2020, through May 31, 2021.


States' backlogs grew substantially during the COVID-19 pandemic. Nationally, 71 percent of nursing homes (10,913 of 15,295) had gone at least 16 months without a standard survey as of May 31, 2021. By State, the backlogs for standard surveys ranged from 22 percent to 96 percent.


Backlogs of standard surveys of nursing homes need CMS's attention. Our updated analysis underscores the importance and urgency of our previous recommendation to CMS to clarify expectations for States to complete backlogs of standard surveys, including by issuing guidance on prioritization of surveys and required timeframes to complete these backlogs. In its response to this recommendation in our report, issued in December 2020, CMS said it will continue working with States on how to address these backlogs. We encourage CMS to take the steps described above to implement this recommendation and help States provide needed oversight of nursing homes.