October 6, 2025
On October 1, 2025, the Centers for Medicare & Medicaid Services (CMS) released QSO-26-01-ALL, a memorandum outlining how state survey and certification (S&C) operations must adapt in the event of a federal government shutdown.
In the memo, CMS covers functions that are not affected by the shutdown, except for functions that are to be continued in the event of a shutdown (also referred to as “essential functions”), and other activities that are directly affected and therefore should not be operational during a federal shutdown.
Below are the activities not supported during a federal government shutdown:
Standard Surveys: No Medicare-funded recertification surveys shall be performed. This includes statutorily mandated surveys (NHs, HHAs), with the exception of hospice surveys mentioned in the memo.
Certain Revisit Surveys: Revisits, including both on-site and desk revisits, that are not required to prevent termination of Medicare participation within the subsequent 45 days shall not be conducted. Among those that should not be conducted are revisits (related to establishing regulatory compliance) that would end a per-day civil monetary penalty or denial of payment for new admissions. Following a federal government shutdown, CMS will issue instructions on how such situations will be handled.
Initial Surveys: No Medicare initial surveys shall be performed, unless otherwise permitted with the allowed activities described in Section A of the memo.
Initial Certification via Deemed Status: States shall not 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.
Certain Complaint Investigations: No Medicare complaint investigations should be performed, except those alleging immediate jeopardy or actual harm to individuals, as noted in the memorandum or as permitted in Section A.
MDS or OASIS: No minimum data set (MDS) or OASIS activities should be conducted except those necessary to maintain provider reporting.
Informal Dispute Resolutions (IDRs): No IDRs or Independent IDRs should be conducted unless they are pursuant to the excepted complaint investigations noted in section B of the memo, for which there is an immediate adverse action that will be taken against the facility or provider during the period of the shutdown.
New CMP-Funded Improvement Projects: No new improvement projects funded by collected civil monetary penalty funds should be implemented unless the CMS location has already granted approval. Projects already approved by CMS are not affected and may continue, since such projects require no further federal action.
In the event of a federal government shutdown that persists for more than a few weeks, CMS may provide further instructions regarding any special provisions that are appropriate for S&C activities. CMS also 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).
For more information about survey and certification activities, see the full CMS memo.