As the federal government shutdown stretches into the longest in U.S. history, there’s finally movement toward resolution. Late Monday night (November 10), the Senate passed a bipartisan funding bill to reopen the government and sent it to the House for an expected vote. Until the House acts and the President signs the bill, the Centers for Medicare & Medicaid Services (CMS) has paused most Medicare survey and certification activities—with Immediate Jeopardy (IJ) and other essential enforcement actions continuing.
For long-term care (LTC) providers, this pause is not a reprieve—it’s a recalibration. The absence of routine survey oversight doesn’t reduce compliance risk; it merely changes its shape. Facilities should continue operating as if an IJ-level investigation could occur at any time, using this window to strengthen documentation, sustain QAPI momentum, and reinforce high-risk systems.
What’s Happening
CMS has directed State Survey Agencies (SSAs) to suspend most Medicare-funded survey and certification work during the shutdown, continuing only “excepted” functions that protect life and property. In practice, that means IJ and actual-harm complaint investigations remain active, related enforcement actions proceed, narrowly defined revisits may occur to prevent termination or a mandatory denial of payment for new admissions (DPNA), and emergency responses continue as usual.
States may close out limited in-progress items (e.g., data uploads) if done promptly—but they may not classify non-excepted work as federal surveys during the funding lapse.
What’s Paused vs. Proceeding
Paused
- Routine Medicare-funded recertification surveys
- Most revisits (unless needed to prevent termination or a statutory DPNA)
- Initial certifications, deemed-status actions, CHOWs, and location changes
- IDRs, new CMP-funded projects not already approved, and federal surveyor trainings
Proceeding
- IJ/actual-harm complaint investigations and related enforcement
- Essential revisits limited to preventing termination or mandatory DPNA
- Emergency responses, including public health events and facility closures
Unaffected by the Medicare Pause (separately funded)
- CLIA and Hospice surveys (funded under the Consolidated Appropriations Act)
- Medicaid-only and state licensure inspections (these do not count as federal surveys during the lapse)
What LTC Facilities Should Do
1. Operate as if IJ could happen today.
Rehearse roles and escalation protocols—who leads, who notifies corporate support, who documents, and who shadows surveyors. Conduct brief daily sweeps of high-risk domains that commonly trigger IJ findings: infection prevention, accidents/supervision, food safety, care plan updates after condition changes, and pain assessment/reassessment.
2. Tighten documentation and notifications.
Ensure paper and EMR records are current: change-in-condition updates within 24–48 hours; post-fall analyses within 24 hours; timely pain reassessments; and consistent alignment across orders, signage, and isolation/PPE logs. Confirm practitioner and responsible-party notifications are documented and reflected in care plans.
3. Stay revisit-ready.
If you’ve alleged compliance on a prior IJ or actual-harm citation, maintain a live “revisit binder” with your plan of correction, training rosters, targeted audits, sustained monitoring data, and time-stamped corrective actions. This helps your state justify an excepted revisit if warranted.
4. Keep QAPI running—don’t coast.
Continue tracking complaints, FRIs, infection exceptions, and falls with injury on a run chart. Use rapid PDSA cycles to close gaps and verify improvements. Readiness is built through consistent routines measured over time.
5. Coordinate with your state.
Ask your SSA which licensure or Medicaid-only activities will continue under state funding and align your preparation accordingly.
Insights from the Field
“For our clients, survey prep and ongoing quality improvement haven’t paused. We’re still seeing facilities eager to continue preparing for their annual recertification surveys and viewing this as a brief intermission—not a stop. Polaris Group consultants are actively coaching and supporting teams through it.”
— Wendy Strain, Director of Consulting, Polaris Group, an Assembly Health Company
The Takeaway
While the Senate’s bill to end the shutdown advances to the House, LTC providers should stay survey-ready. Maintain IJ-level vigilance, reinforce documentation, and keep QAPI activity strong. When survey operations resume, facilities will face a backlog and heightened scrutiny—making sustained readiness your best defense.
Need support with QAPI or survey readiness—during the shutdown and beyond?
Contact Polaris Group Consulting to learn how our consultants can help strengthen your compliance and quality programs.
