Modernizing regulatory oversight for America’s nursing homes
More than 15,000 Medicare and Medicaid certified nursing homes care for over 1.2 million residents across the United States, according to HHS Office of Inspector General nursing home data. Each month, more than 1.7 million resident assessments move through CMS systems, providing the information needed to support inspections, certification decisions, compliance monitoring, and public transparency.
Nursing home oversight often takes place in environments that place unique demands on technology.
Nursing home inspections occur inside active care environments where surveyors must document deficiencies, observations, and supporting evidence as conditions unfold. Many take place in facilities where internet connectivity is intermittent or unavailable, particularly in rural and non-metropolitan areas. Despite these limitations, federal and state users still require timely, reliable information to coordinate oversight activities across the country.
That creates a significant challenge for modern healthcare technology platforms. Traditional enterprise systems often assume continuous connectivity and uninterrupted data exchange. Field-based inspection work rarely operates that way. When documentation becomes fragmented across disconnected systems, handwritten notes, delayed transcription, or inconsistent workflows, operational visibility narrows and coordination becomes more difficult.
Modernizing nursing home survey and certification operations required more than replacing aging technology. CMS needed a resilient national platform that could support field-based regulatory work in real-world conditions while improving coordination across one of the nation’s largest healthcare oversight environments.
To address this challenge, CMS partnered with ICF to modernize the Internet Quality Improvement and Evaluation System (iQIES), the national platform used to manage quality, survey, certification, and compliance data across long-term care providers.
In July 2025, CMS transitioned nursing home survey and certification workflows from the legacy QIES environment into iQIES, consolidating inspections, certifications, provider records, deficiency tracking, and supporting documentation into a single national system. The transition established a more scalable foundation for nationwide survey and certification efforts while reducing reliance on fragmented legacy processes.
Today, tens of thousands of users rely on iQIES to conduct inspections, review provider performance, monitor compliance, and coordinate oversight activities nationwide. The platform maintains 99.99% availability and, as of April 2026, has executed more than 13,000 automated deployments reflecting the engineering practices required to sustain modernization at scale.
Preserving offline capabilities was also essential. Many inspections occur in facilities where internet connectivity is unreliable or unavailable. To address this challenge, iQIES allows surveyors to continue documenting surveys offline and securely synchronize information once connectivity is restored, reducing reliance on fragmented documentation and manual reconstruction after the fact.
3,000
surveyor sessions
875
surveys
835
nursing home providers
From January 2026 to present, more than 3,000 surveyor sessions have used offline synchronization across 875 surveys and 835 nursing home providers. These figures illustrate how frequently surveyors rely on offline capabilities to continue their work when connectivity is unavailable, ensuring inspections can continue even when technology conditions are less than ideal.
Bringing survey and certification activities into iQIES also created a shared environment where federal and state users can review inspection findings, provider history, certification records, and deficiency information within a single system rather than across separate repositories and disconnected processes.
Beyond technology modernization, making a successful transition required thousands of federal and state users to adopt new workflows. CMS and ICF supported this effort through role-specific training, guidance, office hours, and documentation designed to help surveyors, providers, and administrators use the platform effectively.
With information available through a shared national system, nursing home oversight activities can be coordinated more efficiently, and findings can move through the review process more quickly. The information can also be analyzed and made available to the public, supporting informed decision-making for individuals and families evaluating nursing home care options.
Modernized technology, a shared national system, and successful adoption by thousands of users have improved the speed, coordination, and consistency of nursing home oversight nationwide. The effort has strengthened the flow of information that informs inspections, compliance decisions, and public transparency. In partnership with CMS, more than 10 scrum teams and well over 100 engineers at ICF continue to design, build, and enhance these capabilities, helping enable oversight of more than 15,000 nursing homes and the 1.2 million residents they serve. Learn more about ICF's work supporting CMS initiatives.