Colorado and Ohio performed on-site inspections of a random sample of 200 CLIA COW and Provider Performed Microscopy Procedures (PPMP) laboratories. Significant quality and certification problems were identified in over 50 percent of these laboratories. CMS expanded the initial pilot to include 8 additional States across the nation, verifying the scope and seriousness of Colorado and Ohio’s initial findings and other studies. Quality problems were identified in those laboratories. Therefore, CMS is initiating on-site visits to facilities enrolled in CLIA that have COW certificates.