CMS Issues Updated QSO Guidance on Survey and Certification During Shutdown

• By: Maureen Carland
• On: 10/22/2025 11:28:04
• In: Quality/Regulatory

The Centers for Medicare & Medicaid Services (CMS) today released an updated Quality, Safety & Oversight (QSO) memorandum outlining contingency plans for survey and certification activities during the ongoing federal government shutdown. CMS clarified that activities not listed as “excepted” during the shutdown are *not legally authorized* to be performed. Key updates to the previously issued memo include:

Revisits to Prevent DPNA: In addition to previously authorized reasons, states should conduct revisits to prevent a statutorily mandated denial of payment for new admissions (DPNA) at the three-month mark.

Pending CMS-2567 Forms: For surveys completed prior to the shutdown that do not qualify as excepted work, any CMS-2567 not finalized before the shutdown should be held. These forms will remain valid once completed after the shutdown. CMS will issue further instructions on how to complete and process these reports.

Standard Surveys: Processing of recently completed surveys that did not identify immediate jeopardy or actual harm should be paused until normal operations resume.

Authorized Revisit Surveys: Only revisits necessary to (1) confirm the removal of immediate jeopardy or actual harm, (2) prevent Medicare termination within 45 days, or (3) prevent mandatory DPNA within 15 days are authorized. Any other revisits are not permitted. CMS will provide post-shutdown guidance for handling these situations.

Initial Surveys: Medicare initial surveys are suspended unless specifically allowed under QSO exceptions. Medicaid-only surveys may proceed following consultation with the State Medicaid Agency.

Initial Certification: States should not conduct initial surveys or process certification kits for new Medicare applicants, including those pursuing accreditation through CMS-approved programs.

Complaint Investigations: Only complaint investigations alleging immediate jeopardy or actual harm may be performed. States must continue entering all federal allegations into the appropriate information systems.

State-Funded Surveys: States may continue state-funded surveys; however, these will not be recognized as federal surveys during the funding lapse.

Harm-Level Citations: If a facility is cited for a harm-level deficiency, the State must issue a Form CMS-2567 and perform necessary revisits to ensure prompt correction.

Closures: In cases of voluntary nursing home closures, the State remains responsible for ensuring safe resident relocation.

Provider Enrollment Activities: All provider enrollment actions, including initial and change-of-ownership (CHOW) surveys, are suspended until the shutdown ends.

Activities: Contractors may not perform any federal work considered non-excepted during the shutdown.
 
Additional details, including the previously released memo can be found here.  A summary table of all operational guidance, is available here. 
 
For questions, please contact regulatory@ahca.org
 
 
Staff contact: mcarland@mehca.org