This report discusses: deficient care practices occurring in large intermediate care facilities for the mentally retarded (ICFs/MR); whether state survey agencies identify all serious deficiencies in these institutions, and weaknesses in Health Care Financing Admin. (HCFA) and state oversight of quality of care. This information was received from HCFA officials, provider representatives, advocates, researchers, and other experts in the field and there was a review of the relevant literature. U.S. Justice investigation reports and other documentation were reviewed.