On October 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum outlining contingency plans for state survey and certification (S&C) activities during the federal government shutdown. The guidance, effective immediately, remains in place for the duration of the shutdown.
According to CMS, certain survey and enforcement activities conducted by state survey agencies will continue, while others will be paused. Activities that are not affected include Clinical Laboratory Improvement Amendments (CLIA) surveys, which are funded through user fees; hospice surveys funded under the Consolidated Appropriations Act of 2021; and surveys funded solely by state or Medicaid dollars. Work under existing CMS or state contracts that were awarded and funded before September 30, 2025, may also continue.
CMS considers some Medicare-related survey functions essential and has authorized them to continue. These include complaint investigations that involve allegations of immediate jeopardy or actual harm, enforcement actions stemming from such investigations, and revisit surveys necessary to prevent a provider’s Medicare termination. State survey agencies may also respond to emergencies or threats to life or safety, and complete limited tasks needed to ensure an orderly shutdown—such as uploading finalized survey data.
All other Medicare survey and certification activities conducted by state survey agencies are temporarily suspended. These include standard recertification surveys, initial Medicare certification surveys, revisit surveys that are not time-sensitive, complaint investigations that do not allege serious harm, and informal dispute resolutions. CMS has also paused action on initial certifications through deemed status and the implementation of new civil monetary penalty-funded improvement projects unless previously approved.
CMS has designated regional contacts to support state survey agencies during the shutdown and may issue additional guidance if the shutdown continues. State licensure activities and enforcement actions under state law are not affected. CMS advises that this information be shared with appropriate staff immediately.
Compliance Perspective
Issue
On October 1, 2025, CMS issued memorandum QSO-26-01-ALL outlining survey and certification contingency plans during the federal government shutdown. The guidance identifies which state survey activities will continue and which are suspended for the duration of the shutdown. While complaint investigations involving immediate jeopardy or harm will proceed, most standard recertification surveys, revisits, and routine certification work are temporarily paused. Providers should remain aware of which activities state survey agencies are permitted to conduct and prepare for the resumption of full survey functions once funding is restored.
Discussion Points
- Review policies and procedures to support ongoing compliance and survey readiness. While most state survey activities are paused during the federal shutdown, now is a good time to evaluate internal practices related to prior survey findings, Plans of Correction, or high-risk areas identified through QAPI. Consider working with a consultant to conduct targeted reviews or assist in strengthening processes that support regulatory compliance, especially in areas commonly cited during complaint investigations.
- Educate staff about the temporary pause in Care Compare updates and reinforce the importance of ongoing survey readiness. Med-Net Academy offers the course Long-Term Care Survey Process, which reviews entrance requirements, the survey sample selection, the phases of the survey, mandatory facility tasks completed at any time during the survey, triggered facility tasks based on surveyor concerns, 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.
- Consider conducting focused audits or reviews to maintain survey preparedness. With certain survey activities temporarily paused, this period offers an opportunity to proactively evaluate potential risk areas. A focused or modified mock survey—especially in areas previously cited or flagged through your QAPI process—can help identify gaps and guide improvements. Facilities may wish to coordinate with their consultant to structure these reviews effectively and ensure any findings are 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.*