The ongoing partial federal government shutdown that began on October 1, 2013 due to the government funding impasse is having a varied impact on health care provider operations. CMS has ordered Medicare Administrative Contractors (MACs) to continue to perform all Medicare claims processing and payment functions during the government shutdown. Some providers may experience the impact of the shutdown, however, in the form of curtailed survey and certification activities. In short, CMS is directing state survey agencies to continue to investigate and enforce only complaints involving immediate jeopardy or harm to individuals and revisit surveys necessary to prevent provider termination. Many other survey activities are being suspended during the federal government shutdown, including Medicare recertification surveys, revisits that are not required to prevent termination of Medicare participation, Medicare initial surveys, validation surveys, complaint investigations that do not allege immediate jeopardy or actual harm, Patient Safety Initiative Pilot Surveys, MDS or OASIS activities, informal dispute resolutions, or new improvement projects funded by collected civil monetary penalty funds. The shutdown also has hampered federal rulemaking activities; a lengthy shutdown could throw a wrench into CMS efforts to finalize annual Medicare payment rules for systems updated on calendar year basis (including the Medicare physician fee schedule, the hospital outpatient prospective payment system, and the ambulatory surgical center payment system), increasing uncertainty about major proposed policy changes. The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) is continuing Medicare and Medicaid oversight and enforcement activities, including maintaining its fraud and abuse hotline, while most other OIG activities will be suspended during this period. In other areas, the HHS shutdown contingency plan estimates that the shutdown will result in 52% of HHS employees being furloughed, with the Administration for Children and Families, the Substance Abuse and Mental Health Services Administration, the Administration for Community Living, and the Agency for Healthcare Research and Quality having the vast majority of their staff on furlough. A wide range of HHS activities are also being curtailed, including payments under the Children’s Hospital GME Program and Vaccine Injury Compensation Claims, most new National Institutes of Health admissions and grant awards, the Centers for Disease Control and Prevention annual seasonal influenza program, and routine Food and Drug Administration activities not funded through user fees, among many other programs. There is no clear sign of when a deal on a funding bill will be reached.