Editor’s note: On Friday, Oct. 31, the Centers for Medicare and Medicaid Services (CMS) slightly revised its guidance, noting some changes to revisit surveys.

During the ongoing federal government shutdown, many Medicare-related survey and certification activities for nursing homes will be paused, the Centers for Medicare and Medicaid Services (CMS) said in a memo issued Tuesday.

However, despite the shutdown, essential activities deemed necessary for protecting life and safety may continue, the agency said. This includes investigations of complaints or incidents involving Immediate Jeopardy (IJ) or individual harm, related enforcement actions, certain revisit surveys to prevent Medicare termination or payment denials, and emergency responses, such as those related to public health emergencies or facility closures.

“During a lapse in appropriation, it is not legal for CMS or States … 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,” the CMS memo stated. “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.”

State survey agencies (SAs) may also finish tasks that were in progress before the shutdown, such as uploading survey data, if completed quickly, CMS said in the memo.

That said, no Medicare-funded recertification surveys will be conducted, including statutorily mandated ones, unless funded through special provisions like the Consolidated Appropriations Act for hospice.

Revisit surveys for new admissions

Revisit surveys are also being suspended unless they are essential to prevent termination from Medicare or denial of payment for new admissions. Initial surveys and certification actions – including deemed status applications, ownership changes and new locations – are prohibited.

Jodi Eyigor, senior director of nursing home quality and policy at LeadingAge, the largest association of nonprofit long-term care providers, including nursing homes, said the guidance on revisit surveys is helpful.

On October 15, LeadingAge sent a letter to CMS urging changes to enforcement policies during the government shutdown. With survey and certification activities heavily restricted, nonprofit providers had raised concerns about the suspension of revisit surveys and impact of enforcement remedies. LeadingAge recommended that CMS temporarily adjust denial of payment policies to avoid access barriers to post-acute and long-term care services.

“The CMS memo addresses our area of concern – the denial of payment for new admissions – by allowing revisit surveys to take place. This reflects an acknowledgement of our request and is a benefit to our nonprofit and mission-driven members,” Eyigor said in an emailed statement to Skilled Nursing News.

In the memo, CMS issued the following directive regarding revisit surveys: “[Survey agencies] may request approval to conduct a revisit when: (a) A provider or supplier has alleged compliance with CMS requirements (pursuant to a prior determination of noncompliance) and (b) The revisit survey is necessary to determine compliance and prevent the scheduled Medicare termination of a provider or supplier or (c) Prevent a statutorily-mandated (three-month) denial of payment for new admissions.”

On Oct. 31, CMS added that discretionary payment denials can also allow a revisit, provided it follows the same timeframe as a mandatory denial.

“If a discretionary denial of payment has been in effect, the revisit may occur provided it meets the same timeframe as allowed for a mandatory DPNA,” the agency said.

Deferred activities

Complaint investigations not involving immediate jeopardy (IJ) or actual harm must be deferred, the agency said. Additionally, activities like Informal Dispute Resolutions (IDRs), federal surveyor trainings and new civil monetary penalty (CMP)-funded quality improvement projects are not being allowed unless already approved. No assumptions should be made about future funding for these prohibited tasks.

“Routine Medicare provider certification activities 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,” the memo noted. “Survey agencies should check with their State Medicaid Agency regarding the status of routine Medicaid certification activities.”

Certain activities will remain unaffected by the shutdown because these are state-funded or supported by mandatory/user-based funding. These include Clinical Laboratory Improvement Amendments (CLIA) surveys, hospice surveys funded by the Consolidated Appropriations Act of 2021, Medicaid-only facility surveys (with coordination from State Medicaid Agencies), and state licensure surveys – though these cannot be counted as federal surveys during the lapse in appropriations. CMS and state contracts awarded and funded before September 30, 2025, may also continue unless funding expires, the memo stated.

States may not continue prohibited activities with the expectation that funding will eventually resume, the memo noted.

Holly Norelli, vice president of quality & regulatory services at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), lauded CMS’ latest guidance, saying that it will prevent disruption in SNF services and hospital backlogs.

“We’re encouraged that CMS is taking steps to offer clarity, and we’ll continue to seek additional information to guide providers through this shutdown. Authorizing surveys to prevent denial of payment for new admissions will help ensure continuity of care and prevent hospital backlogs,” she said in an emailed statement to SNN. “But we continue to encourage Congress to reach a resolution and end the government shutdown.”

CMS first issued the guidance on Medicare-related survey and certification activities on Oct. 1 after the shutdown began.

The agency will issue further guidance, it stated, if the shutdown continues for an extended period.