​​​​​​​CMS Issues Comprehensive Guidance on Resuming Survey and Certification Activities Post-Federal Shutdown

(Nov. 25, 2025) The Centers for Medicare and Medicaid Services (CMS) has released memorandum QSO-26-02-ALL, a memorandum providing detailed instructions for states and providers on resuming survey, enforcement, and certification activities following the recent federal government shutdown (Oct. 1-Nov. 12, 2025). This guidance addresses operational recovery, enforcement timelines, and reimbursement policies to ensure continuity of oversight and compliance in Medicare and Medicaid programs.

Background​​​​​​​

The shutdown halted most federally funded survey and certification activities, except for “Excepted Activities” such as investigations involving immediate jeopardy (IJ) or actual harm, certain enforcement actions, and revisits necessary to prevent termination. With the enactment of Public Law 119-37, CMS now authorizes full resumption of activities and retroactive reimbursement for work performed since Oct. 1, 2025.

Key Provisions in the CMS Memo

Resumption of Activities​​​​​​​​​​​​​​

• All survey, enforcement, and certification activities should resume immediately.
• States must complete any work suspended during the shutdown.
• Retroactive reimbursement for activities (surveys, training, dispute resolution) conducted since Oct. 1, 2025.

State Licensure vs. Federal Requirements​​​​​​​

• Surveys completed under state licensure during the shutdown must be repeated federally, as CMS does not crosswalk state standards to federal law.
• Complaints investigated under Excepted Activities may be cited as federal deficiencies.

Issuance of CMS-2567 Forms​​​​​​​

• States must issue all pending CMS-2567 Statements of Deficiencies by Dec. 12, 2025.
• For surveys with low-level or no deficiencies, the exit date may be adjusted to:
  • The date the CMS-2567 is issued; or
  • The verified compliance date.
• States should document adjustments in the Internet Quality Improvement and Evaluation System (iQIES) and coordinate with CMS locations for enforcement cycle resolution.

Surveys in Progress​​​​​​​

• Surveys interrupted by the shutdown can continue without restarting, though updates to patient samples or inclusion of new complaint issues may be necessary.
• Off-hours surveys conducted before the shutdown can still count toward the 10% requirement.

Certification for Dually Certified Facilities​​​​​​​

• If a facility met all Medicare and Medicaid requirements during the shutdown and submitted a valid Medicare enrollment application, Medicare certification may be retroactive to the date compliance was achieved.
• The onsite survey date can serve as the certification date for both programs.

Enforcement Timelines​​​​​​​

• Enforcement cycles remain tied to the survey exit date:
  • 90-day remedial action period for non-IJ deficiencies.
  • Nursing home sanctions such as Denial of Payment for New Admissions (DPNA) at three months and mandatory termination at six months.
• Advance notice requirements still apply:
  • IJ deficiencies: Two-day notice for termination or discretionary sanctions.
  • Non-IJ deficiencies: 15-day notice for sanctions other than Civil Monetary Penalties (CMPs) or state monitoring.

Implications for Providers and State Agencies

State survey agencies must prioritize issuing CMS-2567 forms and completing suspended surveys by Dec. 12, 2025. Providers should review enforcement timelines and ensure that corrective actions align with adjusted exit dates.

Contact: Carrie Mosley, cmosley@leadingageny.org, 518-867-8383 ext. 147