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The Health Care Financing Administration (HCFA) oversees how well each state agency ensures quality care in nursing homes, but the mechanisms HCFA uses are of limited scope and effectiveness. Because the mechanisms are not applied consistently in HCFA's 10 regional offices, HCFA lacks sufficient, consistent, and reliable data with which to evaluate the effectiveness of state agencies' performance or the success of its recent initiatives to improve nursing home care. HCFA cannot be certain whether some states are failing to identify serious deficiencies that harm nursing home residents. HCFA also lacks an adequate array of effective sanctions to encourage state agencies to correct serious or widespread problems. GAO recommends that HCFA improve (1) the scope and the rigor of its oversight process through the state surveys and (2) the consistency in how it holds state survey agencies accountable by standardizing procedures for selecting state surveys and conducting federal monitoring surveys. This testimony summarizes the November 1999 GAO report, GAO/HEHS-00-6.