The Centers for Medicare & Medicaid Services (CMS) instituted a partial hiring freeze in July, and at an event in Washington, DC, on November 8, Administrator Chiquita Brooks-LaSure cautioned that the agency’s operations will be in peril if the fiscal standoff in Congress continues. In September, CMS said that it had “sufficient funding” for Medicaid through the end of the year, due to its 2023 appropriations. However, a recent statement by Principal Deputy Administrator Jon Blum said state survey agencies “would likely not be able to complete all statutorily required nursing home surveys” if funds expire and the partial hiring freeze continues.  This alarming assertion comes as the agency ended the comment period for the highly anticipated proposed nurse staffing standard, and, according to CASPER data captured between Oct. 1, 2022, and Sept. 30, 2023, nearly 30% of nursing homes have not had a recertification survey in more than 15 months. This finding is further evidence that there has been little improvement in long-standing survey delays that were worsened by the pandemic.

In May Senator Bob Casey (D-PA) issued a report that was severely critical of CMS’s survey system. The report from the Special Committee on Aging found 32 survey agencies had inspector vacancy rates of 20% or higher, with the highest in Kentucky, Alabama, and Idaho. Senator Casey noted “the current funding uncertainty poses an immense threat to CMS and nursing home state survey agencies around the country. These critical agencies are already facing a crisis of understaffing and underfunding, and a hiring freeze extended by an unnecessary government shutdown would exacerbate a problem that is putting nursing home residents at risk.”