CMS Revises Guidance on State Survey & Certification Activities During a Government Shutdown

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On October 21, 2025, The Centers for Medicare and Medicaid Services (“CMS”) revised guidance to State Survey Agency Directors as to which types of Survey & Certification activities would be affected and put on hold and which would continue during a Federal Government shutdown.[i]  Generally, CMS maintains oversees compliance with the Medicare health and safety standards for laboratories, acute and continuing care providers (including hospitals, nursing homes, home health agencies, end-stage renal disease facilities, hospices, and other facilities) through surveys (inspections). These surveys are generally performed by individual State Survey Agencies on behalf of CMS.[ii]

CMS clarifies that during a government shutdown, 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 (allowable work) includes: 

• Complaint Investigations and Facility Reported Incidents Alleging Harm (revised to include Facility Reported Incidents)
• Certain Federal Enforcement Actions
• Revisit Surveys Approved by Exception and Necessary to Prevent Termination (revised to including surveys to prevent a statutorily mandated denial of payments for new admissions)
• Immediate Threats to Life or Safety (Emergencies and Natural Disasters)
• NEW - Exception for Voluntary Nursing Home Closure
• Orderly Shutdown of Other Tasks

Activities prohibited during a government shutdown include: 

• Standard Surveys (revised to include the processing of completed surveys where IJ or patient harm was not identified)
• Certain Revisit Surveys
• Initial Surveys
• Initial Certification (revised to include via Deemed Status)
• Certain Complaint Investigations
• MDS or OASIS activities
• Informal Dispute Resolutions, unless conducted pursuant to excepted complaint investigations
• NEW - Trainings on the Quality Safety and Education Portal and the Surveyor Minimum Qualifications Test
• NEW - Processing of Certification Actions
• NEW - CMP-Funded Improvement Projects

Additional work allowed during a Federal Government Shutdown includes: 

• CLIA Survey & Certification activities
• Performance under CMS or State Vendor contracts awarded and funded, on or before September 30, 2025
• State funded surveys, including licensure surveys
• Surveys of Medicaid–only facilities
• Hospice Surveys funded through the Consolidated Appropriations Act of 2021.

In summary, expect to see less survey and certification activity during a government shutdown, but not a complete cessation of activities.

If you need assistance with navigating nursing home surveys or another long term care or post-acute care issue, please reach out to Maynard Nexsen for assistance. 

[_{i] QSO-26-01-ALL REVISED at https://www.cms.gov/files/document/qso-26-01-all-revised-2025-10-21.pdf, original at QSO-26-01-ALL https://www.cms.gov/files/document/qso-26-01-all-original-release-date-2025-10-01.pdf.} 

_{[ii] https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information.}