CMS to ‘Crack Down’ on Troubled Nursing Homes Through Special Focus Facility Program Changes

Oct 30, 2022 | Survey & FTags for Staffing, CMS' PBJ Policies

News Digest: PBJ Added to Special Focus Facility Program

CMO’s QSO memorandum beefed up the Special Focus Facility (SFF) program conducted by CMS. The SFF program by statute requires CMS to identify the poorest quality of care facilities by state. CMS shared new SFF methodology to seek to improve “graduation” of non-compliant facilities, as well as reduce the “yo-yo’ing” of facilities in and out of the SFF program.

CMS indicates that because staffing has an important relationship to quality, CMS now recommends choosing SFF program candidates based on a lower staffing Five Star or staffing ratio.



Biden-Harris Administration Strengthens Oversight of Nation’s Poorest-Performing Nursing Homes

As part of the Biden-Harris Administration’s continued commitment to improve the safety and quality of care for nursing home residents, the Centers for Medicare & Medicaid Services (CMS) is increasing scrutiny and oversight over the country’s poorest-performing nursing facilities in an effort to immediately improve the care they deliver. In a series of revisions to the Special Focus Facility (SFF) Program, CMS will toughen requirements for completion of the program and increase enforcement actions for facilities that fail to demonstrate improvement. CMS is also calling on states to consider a facility’s staffing level in determining which facilities enter the SFF Program.

Today’s announcement is part of a series of new actions the Biden-Harris Administration is taking to increase accountability of bad actors in the nursing home industry, improve the quality of nursing homes and make them safer. Today’s action fulfills a promise laid out in President Biden’s State of the Union Action Plan for Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes to overhaul the SFF Program to strengthen scrutiny over more poor-performing nursing homes, improve care for the affected residents more quickly, and better hold facilities accountable for improper and unsafe care.


Assistant Secretary for Public Affairs (ASPA). “Biden-Harris Administration Strengthens Oversight of Nation’s Poorest-Performing Nursing Homes.”, 21 Oct. 2022,


CMS to ‘Crack Down’ on Troubled Nursing Homes Through Special Focus Facility Program Changes

In its latest move to increase scrutiny of the skilled nursing industry, the Biden administration is toughening requirements for nursing homes that fall into its Special Focus Facilities (SFF) program.

Specifically, the Centers for Medicare & Medicaid Services (CMS) is making completion requirements more challenging and increasing enforcement actions if SNFs fail to show improvement, according to a statement issued by the federal agency on Friday.

Criteria for successful completion of the SFF program will now have a threshold that prevents a facility from exiting based on total number of deficiencies, according to CMS. There will be no more “graduating” from the program’s enhanced scrutiny without showing that a facility has made systemic improvements in quality.

SFF program facilities face more severe, escalating enforcement if they show continued noncompliance with “little or no” effort toward improving performance, CMS officials said.

By imposing harsher penalties, CMS hopes operators will work harder to get facilities out of the program at a faster rate. This, in turn, would allow the federal entity to enroll more facilities in the program and “promote sustainability of facilities’ improvements.”


Stulick, Amy. “CMS to ‘Crack Down’ on Troubled Nursing Homes Through Special Focus Facility Program Changes.” Skilled Nursing News, 21 Oct. 2022,


CMS Announces Immediate, Aggressive Enforcement for Special Focus Facilities (SFF) Participants

On Friday, Oct. 21, CMS announced new actions “to significantly strengthen accountability for nursing homes in the Special Focus Facilities (SFF) Program.” According to the White House press release, the “SFF Program already provides more frequent inspections of these nursing homes, but more action is needed to ensure these nursing homes improve.”

CMS will use escalating penalties for violations, including considering facilities with citations for dangerous violations in two successive inspections for termination from Medicare and/or Medicaid funding.

CMS has increased the requirements that an SFF must meet to be successful and graduate from the program. And for those SFFs that graduate from the program, CMS will continue close scrutiny of the facility for at least three years.


“CMS Announces Immediate, Aggressive Enforcement for Special Focus Facilities (SFF) Participants.” LeadingAge Minnesota,


Feds ramp up nursing home sanctions for poor care performance

The federal government is planning to add new penalties against nursing homes that fail to improve a record of providing poor care. The Centers for Medicare & Medicaid Services will more aggressively enforce accountability in its Special Focus Facilities (SFF) program, the Biden administration announced in a fact sheet released Friday, Oct. 21. 

SFFs are nursing facilities that chronically underperform, with those in the program accounting for 0.5%, or 88 of the nation’s facilities. They receive twice the inspections of other facilities, at least once every six months. They must pass two consecutive inspections to successfully complete the program. Under the new changes, they will be monitored longer-term and penalized for backsliding.

Industry advocates pushed back at the plan for escalated enforcement. Increased citations and penalties have historically not made a dent in changing poor performers, the American Health Care Association and National Center for Assisted Living said.

LeadingAge, meanwhile, reiterated its support of federal initiatives to improve care at poorly performing nursing homes, supporting closures of those that do not improve. It also called for an “all-of-government approach to finding solutions that will address the chronic staffing challenge.”


Lasek, Alicia. “Feds Ramp up Nursing Home Sanctions for Poor Care Performance.” McKnight’s Long-Term Care News, 24 Oct. 2022,


CMS toughens stance on worst-performing nursing homes

The Centers for Medicare & Medicaid Services today announced it is increasing its scrutiny of chronically low-performing nursing homes by revising its Special Focus Facility Program.

The agency said it will toughen requirements for completion of the program, increase enforcement actions and lengthen the monitoring period for facilities that enter the program. Showing its commitment to staff improvement, CMS also called on states to consider a facility’s staffing level in determining which facilities enter the SFF Program.

CMS described the changes as a way to “increase accountability of bad actors in the nursing home industry.” There are currently 88 nursing homes in the SFF program, with approximately 400 more on the candidate list. 


Marselas, Kimberly. “CMS Toughens Stance on Worst-performing Nursing Homes.” McKnight’s Long-Term Care News, 21 Oct. 2022,

Related CMS and PBJ Resources

To learn more about the details, policies and information in these articles, please review these CMS and PBJ publications.

Cms qso survey memorandum
QSO Memo 23-01-NH

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