Survey Update During Government Shutdown

Survey Update During Government Shutdown

(REVISED Guidance, 10/31/2025) 

CMS posted and update to the memo, Contingency Plans – State Survey & Certification Activities in the Event of Federal Government Shutdown (QSO- 26-01-ALL-Revised) on 10/31/2025 that provides updates to state survey activity during the ongoing federal government shutdown. The revised guidance appears in red text.  

CMS has instructed CHAP that our survey activity is unaffected, and we will conduct our survey accreditation business as usual. 

The guidance to state survey agencies identifies functions that (a) are not affected by a Federal shutdown, (b) excepted functions that are to be continued in the event of a shutdown (also referred to as “essential functions”), and (c) other activities that are directly affected, are not legally authorized to be performed, and therefore should not be operational during a Federal shutdown. 

  1. State-funded surveys: The lapse in appropriations does not impact on state work for those states that are completing licensure surveys. However, those licensure surveys may not be assumed to count as federal surveys during the period of the lapse in appropriations.  
  1. Surveys of Medicaid-only facilities: States may conduct surveys of Medicaid-only provider types during the shut-down as the first quarter of Medicaid funding will not be impacted. Medicaid funding may remain available and is considered mandatory funding. We advise SA’s to maintain communication with their State Medicaid agency regarding the availability of Medicaid funds for Medicaid-only survey functions.  
  1. Hospice Surveys funded through the Consolidated Appropriations Act (CAA) of 2021: Funding provided by – the CAA is also considered mandatory and is not impacted by the Federal Government shutdown. If your State receives CAA funding to complete hospice survey and certification work, those activities may continue. 

Excepted Medicare Functions During the Shutdown  

During a lapse in appropriation, it is not legal for CMS or States (acting on CMS’ behalf) to carry out federal survey and certification activities beyond those deemed to be “excepted activities”. Excepted activities are those related to the safety of human life or protection of property. If States carry out non-excepted functions under the auspices of the State Government, they should not represent these as Federal Survey and Certification activities. 

  1. Complaint Investigations and Facility Reported Incidents Alleging Harm: Complaints that are triaged as credible allegations of immediate jeopardy (IJ) or harm to an individual should continue to be assessed and investigated according to standard CMS protocols except that, for the duration of any Federal Government shutdown, it is not necessary for SA’s to obtain prior CMS Location approval to conduct a complaint investigation for a deemed provider (approval is normally required).  To assess and follow-up according to standard CMS protocols means that the State is permitted to issue the Form CMS 2567 to the provider and conduct the necessary communication and revisits to ensure that those deficiencies are addressed immediately, with no further harm to patients or residents. 
  1. Certain Federal Enforcement Actions: Enforcement actions that result from surveys noted in the above paragraph 1 should continue to be performed if the surveys indicate a finding of immediate jeopardy or actual harm or there is a need to address a pending termination. States continue to process enforcement and transfer cases that meet the Immediate Imposition of Federal Remedies requirements as these represent resident harm. 
  1. Revisit Surveys Approved by Exception and Necessary to Prevent Termination: SA’s may request approval to conduct a revisit when:  
    • A provider or supplier has alleged compliance with CMS requirements (pursuant to a prior determination of noncompliance) and  
    • The revisit survey is necessary to determine compliance and prevent the scheduled Medicare termination of a provider or supplier, and  
    • Prevent a statutorily mandated (three-month) denial of payment for new admissions. If a discretionary denial of payment has been in effect, the revisit may occur provided it meets the same timeframe as allowed for a mandatory DPNA. 
        1. Immediate Threats to Life or Safety (Emergencies and Natural Disasters): SAs should take action to prevent or mitigate any other immediate threats to the life or safety of a beneficiary even if the situation does not fit into any of the preceding categories, such as survey and certification activities that may be necessary during a declared public health emergency to prevent injury or harm to beneficiaries. 
        1. Voluntary Nursing Home Closure: If a nursing home provider voluntarily closes, the routine monitoring and oversight by the SA to ensure the orderly and safe relocation of nursing home residents may continue. 
        1. Orderly Shutdown of Other Tasks:  Note that surveys completed before the Federal Government shutdown that do not fit into the above noted categories, for which the written survey report Form CMS-2567) has not been completed prior to the orderly shutdown, should be held and not issued, and will generally remain valid if completed after the shutdown. We plan to issue special instructions for completion of such reporting. 

        States are instructed to maintain infrastructure capability to support the complaint investigations, enforcement, and survey information system entries for Medicare activities authorized in this communication. This must include the ability to receive all complaints and respond to those complaints that allege immediate jeopardy or actual harm to individuals. 

        Activities Prohibited During a Federal Government Shutdown  

        Survey & Certification functions normally conducted on behalf of CMS that do not fall into one of the above categories shall not be performed during the period of a Federal Government shutdown. 

        1. Standards surveys: No Medicare-funded recertification surveys shall be performed. This includes statutorily mandated surveys (NHs, HHAs), except for hospice.  Any processing of recently completed surveys where immediate jeopardy or patient/resident harm has not been identified should be held until funding is restored. 
        1. Certain revisit surveys: The only authorized and excepted revisits are those necessary to 1) ensure that immediate jeopardy or actual patient/resident harm has been addressed, 2) prevent termination of Medicare participation within 45 days of the termination date or 3) prevent mandatory denial of payment for new admissions within 15 days of imposition. A revisit for any other reason is not authorized or excepted. We will issue instructions on how those situations will be handled once the shutdown ends. SAs may remove any enforcement remedies, as appropriate, as a result of an excepted revisit. 
        1. No Medicare initial surveys shall be performed, unless otherwise permitted with the allowed activities described above.  For example, Medicaid-only surveys may continue upon consultation with the State Medicaid Agency. 
        1. Initial certification (including via Deemed Status): States shall not conduct any initial surveys or take any action on initial certification kits (e.g., compiling the documentation for an initial certification kit) for applicants to participate in Medicare who seek to demonstrate compliance via accreditation under a CMS-approved Medicare accreditation program. 
        1. Certain complaint surveys:  No Medicare complaint investigations should be performed, except those alleging immediate jeopardy or actual harm to individuals, as noted in this memorandum or as permitted by the above information.  All intakes with federal allegations are still required to be entered into the federal information systems. 
        1. MDS or OASIS: No minimum data set (MDS) or OASIS activities should be conducted except those necessary to maintain provider reporting. 
        1. Informal Dispute Resolutions (IDRs): No IDRs or Independent IDRs should be conducted unless they are pursuant to the excepted complaint investigations noted above in section B of this memorandum for which there is an immediate adverse action that will be taken against the facility or provider r (i.e., termination of the provider agreement) during the period of the shutdown. 
        1. Training Courses on the Quality Safety and Education Portal and the Surveyor Minimum Qualifications Test (SMQT): Any training activity for which there is an expectation of federal reimbursement is prohibited until funding is restored. However, surveyors may take training, including required trainings and pre-requisites on QSEP, as there is no direct federal reimbursement for those activities. Surveyors may take the SMQT test, as it supports the state’s overall health and safety oversight capacity and does not incur a direct federal expense.  
        1. Processing of Certification Actions: Routine Medicare provider certification activities such as initial certifications, changes of ownership, and changes of location are not considered excepted activities and will not be completed until there is a restoration of funding. SAs should check with their State Medicaid Agency regarding the status of routine Medicaid certification activities. 

        CMS stated expects that there will be additional guidance to address timelines impacted by the shutdown included in the State Performance Standards System (e.g., timelines related to selection of a new Special Focus Facility). If there are any specific questions, please direct them to your CMS Location Point of Contact. 

        They designated a limited number of individuals who will maintain communications with State Survey Agencies and will be able to take authoritative action about Federal survey and enforcement activities. The CMS Survey & Operations Group Leadership points of contact are listed in the memo. 

        Questions?  Contact CHAP