The Special Focus Facility (“SFF”) Program is an ongoing initiative in which the Centers for Medicare and Medicaid Services (CMS) selects a set number of nursing homes in each state as a Special Focus Facility. CMS generates a list of poor performing facilities in a state from recent survey results and shares that list with that state’s Survey Agency (“SA”) so that the SA can recommend which nursing homes should be made SFFs.

Although designation as an SFF has always put those facilities under additional scrutiny, CMS recently updated the SFF Program by escalating consequences for non-compliance. SFFs now face remedies of “increasing severity” any time an SFF has a survey with deficiencies cited at a scope and severity level of “F” or higher. “Increasing severity” may mean higher civil monetary penalties (“CMP”) or more than one remedy being imposed, such as issuing both a CMP and a directed plan of correction. Additionally, SFFs will no longer graduate out of SFF designation without showing systematic improvements in quality. Finally, SFFs cited with Immediate Jeopardy deficiencies on any two surveys will be considered for discretional termination from the Medicare and/or Medicaid programs.

In addition to severity of consequences, CMS updated the SFF Program by directing SAs to consider facility staffing when recommending which of the poorest performing facilities should be placed under SFF designation. This means that when two equally poorly performing nursing homes are being considered, the SA should recommend the one with less staffing for placement in the SFF Program.