In a newly released September 2026 Report, the Office of the Inspector General (OIG) found that 100% of the State Agencies (SA) that used contract surveyors to conduct nursing home surveyors could have improved their policies and procedures to ensure that CMS guidelines were met. While the report primarily pushed at CMS to provide additional oversight – an idea that the Agency refuted – there are several tidbits which could be of interest to nursing home providers.
What OIG Found
- OIG previously identified that State Agencies were not meeting CMS performance standards due to a backlog of required surveys and staffing shortages at the SAs. This coincided with SAs using more contract staff to conduct these surveys.
- CMS holds the State Agencies responsible for ensuring contract surveyors are qualified. OIG determined that, for all fourteen states it reviewed, each could do a better job with policies surrounding the use of contract staff and their qualifications.
- CMS was not able to easily identify to OIG which nursing home surveys had been conducted by contractors and which were conducted by SA staff. That was a limitation of ASPEN . . . and the same issue remains with iQIES.
CMS’s Response
The response from CMS to OIG validates information we’ve seen all along:
- Nursing home complaint investigations have increased by over 20%
- The Survey & Certification budget isn’t being increased and hasn’t been for some time
- COVID-19 created a mess related to S&C activities and created a huge survey backlog
Complaint Triage: The Numbers Behind the Timeframes
An interesting fact, however, is that “nearly all” State Agencies eliminated or nearly eliminated the backlogs of the most serious complaint investigations in FY 2025. The response indicates that:
- the most serious of complaints are “generally” investigated on-site within three days
- less serious complaints are investigated within 15-45 days
This is exactly why triage speed matters so much: complaint investigations account for less than a third of all nursing home citations nationally, but 78.1% of Immediate Jeopardy findings and 72.5% of all Actual Harm/Immediate Jeopardy citations combined come from complaints rather than standard surveys. A delayed complaint investigation isn’t just a paperwork backlog — it’s a delay specifically concentrated in the cases most likely to involve serious resident harm.
The Standard Survey Backlog – State by State
We thought it would be interesting to see how many states are currently meeting these timeframes. The response also states that budgeting for standard surveys has been reduced to accommodate the influx in complaint surveys. We don’t have visibility into complaint-triage timeliness by state, but we can show where that “reduced standard survey budgeting” the response mentions is actually landing.
Based on our data, nationally, roughly 1 in 4 nursing homes (25.5% as of August 2026) are currently overdue for their statutorily required standard survey — the survey CMS regulations require at least once every 15 months. That national figure has ticked down slightly since June (26.7%), but it masks enormous state-level variation: only 7 states have fewer than 5% of facilities overdue, while 19 states have more than a quarter overdue. Alabama is the most extreme case by far, with 91.5% of nursing homes overdue — the median facility’s last standard survey was in May 2022, over four years ago. Virginia (75.1%) is the only other state above 70%.
Read the OIG Report, “CMS Could Improve Oversight of States’ Use of Contract Surveyors for Nursing Home Surveys” (A-04-24-08105) for more details.
