The Centers for Medicare & Medicaid Service ("CMS") recently announced that it will begin toughening program requirements and oversight for nursing homes participating in its Special Focus Facility ("SFF") Program, a CMS initiative to rehabilitate poorly performing nursing homes. Under the SFF program, participating nursing homes are inspected biannually regarding their adherence to Medicare health and safety requirements. Based on these inspections, CMS issues recommendations for progressive enforcement (e.g., civil money penalties, denial of Medicare payment, etc.) until the nursing home either (1) graduates from the program; or (2) is terminated from the Medicare and/or Medicaid program(s).

CMS's proposed overhaul of the SFF program consists of four main tenets:

  1. Toughening Program Requirements: CMS is strengthening the criteria for successful completion of the SFF Program by adding a threshold that prevents a facility from exiting based on the total number of deficiencies cited. Facilities will need to demonstrate systemic improvements in quality to graduate from the program.
  2. Termination of Non-Improving Facilities: CMS will consider all facilities cited with Immediate Jeopardy deficiencies on any two surveys while in the SFF Program for discretionary termination from the Medicare and/or Medicaid programs.
  3. Enhancing Enforcement Actions: CMS is imposing more severe, escalating enforcement remedies for SFF Program facilities that have continued noncompliance and little or no demonstrated effort to improve performance.
  4. Incentivizing Sustainable Improvements: CMS is extending the monitoring period and maintaining readiness to impose progressively severe enforcement actions against nursing homes whose performance declines after graduation from the SFF Program.

CMS further recommended that facilities make good faith efforts to improve quality and make measurable changes, such as by engaging CMS Quality Improvement Organizations and hiring external consultants to support performance improvement, as such efforts will be considered when evaluating potential enforcement actions for noncompliance.

The changes to the SFF program are effective immediately, with the CMS Center for Clinical Standards and Quality/Quality, Safety & Oversight Group advising facilities to advise staff within 30 days.

Originally published October 26, 2022

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