On October 21, 2025, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance regarding survey and certification activities during the federal government shutdown. The update builds on the October 1 memorandum and includes several important clarifications and limitations that providers and facilities should be aware of. The updated memo is effective immediately and remains in place until the federal funding lapse is resolved.
CMS reiterates that only “excepted” functions—those necessary to protect human life or property—are legally permitted under federal law during the shutdown. State survey agencies (SAs), and contractors working on behalf of CMS, may not perform other federally funded survey activities, even if they expect funding to become available later.
Among the key clarifications in the updated guidance:
- Complaint investigations and facility-reported incidents that allege immediate jeopardy or actual harm continue to be permitted. States are authorized to investigate, issue Form CMS-2567, and conduct revisits to ensure prompt correction of identified deficiencies in these cases.
- Revisits are now more narrowly limited to those needed to prevent Medicare termination, avoid mandatory denial of payment for new admissions, or to verify correction of immediate jeopardy or actual harm deficiencies. All other revisit surveys remain prohibited.
- State oversight of voluntary nursing home closures is now included as an allowable activity if it is necessary to ensure safe resident relocation.
- Federal contractors may only continue working on contracts awarded and funded before September 30, 2025—and only for excepted work. Even with pre-existing funding, non-excepted activities are not permitted during the shutdown.
- Informal Dispute Resolutions (IDRs), federal surveyor training, and the Surveyor Minimum Qualifications Test (SMQT) are generally not authorized during the shutdown. However, CMS now clarifies that IDRs or Independent IDRs may proceed only if they are connected to an excepted complaint investigation that will result in an immediate adverse action—such as termination of a provider agreement—during the shutdown period.
- CMS has emphasized that no routine provider certification work, including initial certifications, changes of ownership, or changes in location, may proceed at this time.
CMS also confirmed that certain activities are unaffected by the shutdown and may continue:
- CLIA-related surveys funded through user fees
- Surveys funded by state-only dollars
- Medicaid-only surveys may continue, provided state Medicaid funding is available. CMS also notes that related activities—such as Nurse Aide Training and Competency Evaluation Programs (NATCEP)—may proceed, but states are advised to consult with their Medicaid agency regarding available resources.
- Hospice surveys funded through the Consolidated Appropriations Act of 2021.
- Work performed under CMS or state contracts awarded and funded before September 30, 2025.
Although certain activities may continue, CMS clarified that surveys completed before the shutdown, but not yet finalized, will generally be held until further notice, unless they are tied to an excepted function such as immediate jeopardy or actual harm.
As the shutdown continues, CMS may issue further updates to address timelines and other operational issues. Providers should ensure that relevant staff are aware of these limitations and monitor for additional guidance.
The updated memorandum is available here.
Compliance Perspective
Issue
On October 21, 2025, CMS issued a revision to memorandum QSO-26-01-ALL, providing updated guidance on state survey and certification activities during the federal government shutdown. The revised memo reinforces which activities may continue—such as investigations involving immediate jeopardy or harm—and clarifies that other functions, including most standard surveys, revisits, and certification actions, remain paused. Providers should stay current on what survey work is permitted and prepare for full resumption once federal funding is restored.
Discussion Points
- Review policies and procedures to ensure continued compliance and survey readiness. Even though most federal survey activity is suspended during the shutdown, providers should take this time to evaluate systems and practices related to recent survey outcomes, Plans of Correction, or known high-risk areas. A focused policy review—especially with input from an external consultant—can help strengthen regulatory compliance and ensure readiness when surveys resume.
- Educate staff about the current limitations on survey activity and emphasize that core expectations around compliance and quality remain unchanged. Med-Net Academy offers the course Long-Term Care Survey Process, which reviews entrance protocols, sample selection, the survey phases, and both mandatory and triggered facility tasks, and the purpose and scope of Survey Pathways (formerly known as Critical Element Pathways). This training helps staff understand the survey process in detail, supporting ongoing preparedness and quality improvement efforts.
- Use this period to conduct focused audits or reviews in priority areas. While many survey functions are on hold, facilities can still benefit from proactive evaluations tied to recent citations or QAPI findings. A mock survey can help identify areas for improvement. Engaging a consultant may help structure these reviews effectively and ensure findings are promptly addressed before survey activity resumes in full.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*