The GAO has issued two recent reports on nursing home quality of care and sanctions. The first report found that a substantial percentage of state nursing home surveyors and state agency directors identified general weaknesses in the nursing home survey process, including both the survey methodology and guidance on identifying deficiencies. The GAO makes a series of recommendations to CMS to address concerns about CMS’s survey methodology and guidance, workforce shortages, insufficient training, inconsistencies in supervisory review of deficiencies, and state agency practices and external pressure that may compromise survey accuracy. Accompanying the report, “Nursing Homes: Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment,” is a document with additional information regarding the feedback the GAO received from nursing home surveyors and state agency directors. The second report, “Nursing Homes: Opportunities Exist to Facilitate the Use of the Temporary Management Sanction,” notes that the federal temporary management sanction has been used successfully by some states where there was some combination of immediate jeopardy, a history of noncompliance with CMS quality requirements, or the failure of other sanctions to bring about compliance. Several obstacles to using federal temporary management were identified, however, including time constraints, a lack of qualified temporary managers, and inadequate funding to pay for a temporary manager. In response, the GAO recommends that CMS: (1) create and maintain lists of qualified temporary managers; (2) identify best practices, such as when and how to use the sanction; and (3) develop guidance for states to help ensure the longer-term compliance of homes that have undergone temporary management.