This post is an update of our post from earlier in October regarding the October 1, 2025 CMS QSO Memo about contingency plans related to the Federal government shutdown.
*Updates from the revised QSO Memo will be indicated in italics and with an asterisk.
On October 21, 2025, CMS issued a revised QSO Memo to clarify activities which are permitted or not legally permitted during the continuing government shutdown.
On October 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a QSO Memo, “Contingency Plans – State Survey & Certification Activities in the Event of a Federal Government Shutdown.” The Memo covers three areas, but we want to highlight one of them as it pertains to the update of survey data.
We know that Nursing Home Compare updates had already been paused (and then partially un-paused) to allow for data validation post-iQIES crossover. One section of this memo, “Orderly Shutdown of Other Tasks,” provided information to State Agencies regarding their “shutdown tasks” that could be initiated in advance of September 30, 2025. This included uploading completed surveys to ASPEN and iQIES. It also addresses how states should handle written CMS-2567s which were not completed prior to the shutdown. This indicates that the October 30, 2025 data for the full refresh for Nursing Home Compare could be in limbo – or at least not be as comprehensive as it could be.
The Memo also directs State Agencies to ensure that their infrastructure remains operable so the Agency can receive all complaints and respond to complaints where there is an allegation of actual harm or immediate jeopardy – more on that next.
*Clarification regarding the orderly shutdown of tasks and 2567s – if a survey completed prior to the shutdown does not fit into one of the categories below and the SOD had not been completed prior to the shutdown, the 2567 should be held and not issued.
Excepted Medicare Functions During the Shutdown
CMS notes in the original 10/1/2025 QSO Memo that it considers several functions to be essential and should continue even during a federal government shutdown, so heads up that there are instances when you may get a visit from a surveyor.
*Per the revised Memo: “It is not legal for CMS or States, acting on behalf of CMS, 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 State Government, they should not represent these as Federal Survey and Certification activities.”
Complaint Investigations where there is an Allegation of Harm or Immediate Jeopardy – *Revision: “Complaint Investigations and Facility Reported Incidents”
- Complaints which are credible and have been triaged as allegations of harm or immediate jeopardy (IJ) will continue to be assessed and investigated according to usual protocols.
- During the federal government shutdown, the State Agency would not have to obtain the CMS location’s prior approval to conduct a complaint investigation for a deemed provider.
*Clarification: “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 communications and revisits to ensure that those deficiencies are addressed immediately, with no further harm to patients or residents.”
Certain Enforcement Actions
- For enforcement actions which result from complaint investigations where harm or IJ has been identified per the above, the State Agency should continue to act related to enforcement. This includes processing enforcement and transferring cases which require an Immediate Imposition of Federal Remedies.
- For situations where a pending termination has been identified, continued work is considered essential and should not be delayed.
Some Revisit Surveys
*Clarification/Additions: “Certain Revisit Surveys: The only authorized and excepted visits are those necessary to 1) ensure that immediate jeopardy or actual patient/resident harm has been addressed, 2) to 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.“
Revisit surveys which have been approved by exception and deemed necessary to prevent termination of a provider may be conducted by the State Agency, with approval, under certain conditions. All of the following conditions must be met for the State Agency to request an exception with CMS.
- The provider has alleged compliance and
- The revisit survey is needed to determine the provider’s compliance and prevent a scheduled Medicare termination and
- Due to timing or other, specific circumstances, the scheduled Medicare termination will likely occur
- Addition: “Prevent a statutorily-mandated (three-month) denial of payment for new admissions”
Emergency or Natural Disasters
- If there is an immediate threat to life or safety due to an emergency or natural disaster, the State Agency should take action to address/prevent further threats, even if the scenario doesn’t fit into one of the excepted categories for survey activity.
- CMS locations which are operating related to this situation would continue operating in order to assist with emergency needs.
*Addition: “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.”
Survey and Certification Activities Not Affected by a Federal Government Shutdown
The following S&C activities have been determined not to be impacted by the shutdown:
- State-funded surveys – Any states that use state-only funding for surveys can continue to do those. *Clarification: Licensure surveys may not be assumed to count as federal surveys during the period of the lapse in appropriations.
- Medicaid-only Facility Surveys – Medicaid funding is considered mandatory funding and remains available, so states may conduct surveys of facilities which only receive Medicaid. *Clarification: Medicaid funding may remain available — the initial Memo indicate it “remains available.”
- Hospice Surveys – Funding that was provided as part of the CAA Act of 2021 is considered mandatory, so these surveys may continue. *Clarification: If a State receives CAA funding for hospice S&C activities, these may continue.
- CLIA S&C activities
- Performance under CMS or State Vendor Contracts which were awarded on or before 9/30/2025. *Addition/clarification: contractors may not perform federal work that is otherwise prohibited as non-excepted activities regardless of funding.
Survey and Certification Activities Not Supported during a Federal Government Shutdown
Although it remains to be seen how long the shutdown will last, there are a handful of routine S&C activities which would not fall into any of the other categories addressed in this Memo and therefore will not be performed during the shutdown. Here’s what to know:
- Standard Surveys, including statutorily mandated Medicare-funded recertifications surveys for nursing homes and home health agencies will not be conducted. (An exception to hospice surveys was noted above). *Clarification: “Any processing of recently completed surveys where immediate jeopardy or patient/resident harm has not been identified should be held until funding is restored.”
- Complaint Surveys for Medicare complaint investigations which do not rise to allegations of actual harm or immediate jeopardy are paused. *Clarification: “All intakes with federal allegations are still required to be entered into the federal information systems.”
- MDS and OASIS activities are paused, except for anything required to ensure providers can report.
- IDRs/IIDRs cannot be conducted unless they are linked to the excepted complaint investigations indicated above where immediate adverse action needs to be taken against a provider during the shutdown.
- Some Revisit Surveys, particularly those which are not required to prevent termination will not occur. This includes both on-site revisit surveys and desk revisits. Specifically, revisits required to end a per-day CMP or denial of payment for new admissions (DPNA) should not occur.
- Initial Surveys will not occur (unless meeting an exception above) and Initial Certification via Deemed Status activities will be paused.
- New CMP-funded Improvement Projects are also paused unless a CMS location has already provided approval.
- *Clarification/Addition: Trainings on the Quality Safety and Education Portal and the Surveyor Minimum Qualifications Test (SMQT): Federal training resources including the Quality Safety and Education Portal have not been removed from the government website as a resource; however, taking surveyor training or completion of the SMQT test is not considered an Excepted activity during the lapse in funding.”
- *Clarification/Addition: “Processing of Certification Actions: Routine Medicare provider certification actvities 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.”
