Since 2001 there has been a 21.4% increase in the overall number of Medicare-certified providers to be surveyed. Among all types of facilities, the numbers of home health agencies (HHAs), ambulatory surgical centers (ASCs), and dialysis facilities (ESRD) have grown the fastest (increasing by 69.3%, 60.8%, and 37.3% respectively, between 2001 and 2010). New and expanded responsibilities have further increased the S&C workload. For example, due to improved Centers for Medicare & Medicaid Services (CMS) quality of care and safety expectations for dialysis facilities, average hours per ESRD survey recently increased by 37%. The fiscal year 2012 has already begun, and we expect it will still take some time before the full Congress acts on legislation to fund the FY2012 Centers for Medicare & Medicaid budget. However, early indications are that the budget level for Medicare survey & certification (S&C) will most likely be 10%-12% less than the level requested by the President. Therefore, we believe it is prudent to prepare now for a lower FY2012 funding level than previously expected. Fortunately, CMS and States have worked to develop a variety of methods to increase efficiency and effectiveness. While these efforts may not entirely address the difference between the requested and likely budget levels, they will mitigate negative effects. Additional efforts will be necessary, and expectations for FY2012 funding will need to be adjusted.