Shutdown Rules, Survey Reality: What Providers Need to Know Now
A federal government shutdown creates uncertainty across many areas of healthcare oversight, and survey activity is no exception. To address this, the Centers for Medicare & Medicaid Services (CMS) has re-issued updated guidance clarifying how Survey & Certification activities must be handled during a partial, temporary federal government shutdown.
The revised guidance, QSO-26-01-ALL REVISED, was issued to State Survey Agencies and confirms that CMS’ long-standing contingency framework remains in place. While the memo is updated, the core expectations for survey operations during a shutdown have not changed.
The full QSO can be accessed here.
CMS’ Core Position During a Shutdown
CMS reaffirmed that during a federal shutdown, Survey & Certification work is legally limited to activities necessary to protect resident health and safety. In practical terms, this means that routine oversight and administrative survey functions are paused unless there is a direct connection to preventing harm or addressing serious safety risks.
This limitation is not discretionary, it is driven by federal law governing agency operations during a lapse in appropriations.
Survey Activities That Are Paused
Under the updated QSO, CMS confirmed that the following activities will not continue during a shutdown:
- Standard (annual) recertification surveys
- Initial Medicare certification surveys
- Complaint investigations that are triaged at non-harm levels
- Most revisit surveys
- Informal Dispute Resolutions (IDRs)
- Routine certification processing and related actions
For providers, this means that many expected survey-related timelines may temporarily stall, even though facilities remain responsible for ongoing compliance.
Survey Activities That May Still Occur
CMS also clarified that some survey activity may continue when it is directly tied to resident safety or Medicare participation. These include:
- Complaint investigations involving Immediate Jeopardy or actual harm
- Actions required to address serious life-safety concerns
- Revisits conducted only when necessary to prevent mandatory termination from Medicare participation
These activities are narrowly focused and are intended to ensure that critical risks to residents are addressed, even during a shutdown.
What the Re-Issued Guidance Means for Providers
Although CMS has updated and re-issued the QSO, the agency emphasized that the same shutdown framework remains in effect. The revised memo does not introduce new survey categories or expectations; instead, it reinforces existing policy and provides confirmation that prior guidance still applies.
Providers should not interpret a pause in routine survey activity as a relaxation of compliance obligations. Standards remain in effect, and survey activity may resume once the shutdown ends.
Ongoing Monitoring
HTS will continue to monitor CMS communications related to the federal shutdown and Survey & Certification activity. HTS Partners will be notified promptly if CMS issues additional clarification or changes to this guidance.
Power Points
During a federal government shutdown, survey activity becomes narrowly focused on resident health, safety, and Medicare participation. CMS’ updated QSO-26-01-ALL REVISED confirms that while many routine surveys pause, enforcement tied to serious risk continues.
Written By: Sheena Mattingly, EVP of Quality & Compliance
