CMS narrows surveys to immediate jeopardy, harm during shutdown

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) has activated shutdown rules that confine Medicare survey and certification work to health and safety essentials, according to an October 21 memo from the agency. Per the revised memorandum, excepted work during the federal shutdown includes investigations of complaints and facility-reported incidents alleging immediate jeopardy or harm, related enforcement actions, limited revisits to prevent termination or mandatory payment denials, responses to emergencies and disasters, and oversight of voluntary nursing home closures.

What continues without interruption: CLIA survey and certification functions will proceed because they are user-fee funded. Hospice surveys financed by the Consolidated Appropriations Act of 2021 may continue. States may also conduct surveys of Medicaid-only providers given the availability of mandatory Medicaid funding in the first quarter. Existing CMS or state vendor contracts awarded and funded on or before September 30 can continue, though contractors cannot perform non-excepted federal work.

Activities being halted include Medicare-funded standard recertification surveys, most revisits that do not address jeopardy or imminent enforcement milestones, initial certifications and related actions (including deemed status), complaint investigations that do not allege immediate jeopardy or actual harm, informal dispute resolutions except in limited adverse-action scenarios, surveyor training and SMQT testing, processing routine certification actions such as changes of ownership or location, and approval of new CMP-funded improvement projects. States should not conduct these tasks as federal work during the lapse.

Operationally, states must maintain infrastructure to receive and triage all complaints, act on those alleging immediate jeopardy or harm, and enter data in ASPEN and iQIES. CMS has named regional points of contact to authorize excepted activities and handle enforcement questions. This policy lasts only while the federal government remains in shutdown status.