CMS Halts Survey and Certification Activities During the Federal Government Shutdown

Certain flexibilities that the federal government provided for telehealth services rendered to Medicare beneficiaries expired on Sept. 30, 20In light of the continued federal government shutdown (the Shutdown), the Centers for Medicare & Medicaid Services (CMS) Quality, Safety & Oversight Group and Survey & Operations Group issued a revised memorandum (the Memo) on Oct. 21, 2025, to clarify what the Shutdown means for Medicare-certified providers and suppliers: outside of those activities deemed to be “excepted,” nearly all state survey and certification activities are currently suspended.

The Memo revises the initial memorandum released on Oct. 1, 2025, and identifies functions that are not affected by the Shutdown; “excepted” functions that are to be continued during the Shutdown; and other activities and functions that are not legally authorized to be performed during the Shutdown.

The ongoing Shutdown is anticipated to significantly delay actions that require CMS certification and should therefore be taken into consideration when planning for any current or future projects. Such delays have the potential to impact both transactions and business operations by slowing billing activities and the receipt of payment for services.

Survey and Certification Activities Not Affected by the Shutdown

• Clinical Laboratory Improvement Amendments (CLIA) survey and certification functions
• CMS or state vendor contracts awarded on or before Sept. 30, 2025 – however, contractors may not perform federal work that is otherwise prohibited as non-excepted activities
• State licensure functions and state enforcement activities under state law – however, state licensure surveys cannot count as federal surveys during the Shutdown
• Surveys of Medicaid-only facilities
• Hospice surveys funded through the Consolidated Appropriations Act (CAA) of 2021

“Excepted” Medicare Functions During the Shutdown

• During the Shutdown, neither CMS nor states acting on behalf of CMS are legally authorized to carry out federal survey and certification activities beyond those deemed to be “excepted activities,” which includes activities related to the safety of human life or protection of property. “If States carry out non-excepted functions under the auspices of the state government, they should not represent these as federal survey and certification activities.”  CMS considers the following activities to be “excepted:”
  • The assessment and investigation of complaints and facility-reported incidents alleging immediate jeopardy or actual harm to an individual and the imposition of federal enforcement actions resulting from the same
  • The processing of enforcement and transfer cases that meet the Immediate Imposition of Federal Remedies requirements, as these represent resident harm 
  • The conducting of revisit surveys when:
    • A provider or supplier has alleged compliance with CMS requirements (pursuant to a prior determination of non-compliance); and
    • The revisit survey is necessary to determine compliance; and prevent the scheduled Medicare termination of a provider or supplier; or prevent a statutorily-mandated (three-month) denial of payment for new admissions.
  • State survey agency action to prevent or mitigate any other immediate threats to the life or safety of a beneficiary, even if the situation does not fit into any of the previously discussed categories
  • The routine monitoring and oversight by a state survey agency to ensure the orderly and safe relocation of nursing home residents if a nursing home provider voluntarily closes

Activities Prohibited During the Shutdown:

• Medicare activities that cannot be continued during the Shutdown include:
  • Medicare certification and recertification surveys, including initial, standard and “Deemed Status” surveys conducted by a CMS-approved Medicare accreditation program
  • Most revisit surveys, except those necessary to:
    • Ensure that immediate jeopardy or actual patient/resident harm has been addressed
    • Prevent termination of Medicare participation within 45 days of the termination date
    • Prevent mandatory denial of payment for new admissions within 15 days of imposition.
  • Most complaint investigations, except those alleging immediate jeopardy or actual harm to individuals
  • MDS or OASIS activities, except those necessary to maintain provider reporting
  • Informal Dispute Resolutions (IDRs), except when an immediate adverse action will be taken against the facility or provider during the Shutdown, such as the termination of the provider agreement 
  • Surveyor training and testing
  • The processing of routine Medicare provider certification activities such as initial certification, changes of ownership and changes of location
  • New CMP funded improvement projects

The Health Law Observer will continue to monitor the Shutdown and provide updates on the resumption of any of these activities as applicable.