Reports since 1998 have demonstrated that state surveyors, who evaluate the quality of nursing home care on behalf of CMS, sometimes understate the extent of serious care problems in homes because they miss deficiencies. CMS oversees the effectiveness of state surveys through the fed. monitoring survey program. In this program, fed. surveyors in CMS¿s regional offices either independently evaluate state surveys by resurveying a home (comparative surveys) or directly observe state surveyors during a routine nursing home survey (observational surveys). This report evaluates the information fed. monitoring surveys provide on understatement and the effectiveness of CMS mgmt. and oversight of the survey program. Includes recommend. Illus.