On Oct. 21, 2022, CMS issued QSO-23-01-NH, announcing revisions to the Special Focus Facility (SFF) program with an emphasis on improving the quality of care that residents living in SFF receive. The changes to the program aim to address facilities that remain in the SFF program for too long and those with “yo-yo” noncompliance after graduating from the program.

Facilities in each state with the most points assigned, based on scope and severity of deficiencies received from the last three standard surveys and complaint surveys in the past three years are selected as candidates for the SFF program. You can learn more about how the SFF program works and see the listing of SFF and SFF candidates at https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/downloads/sfflist.pdf

Key changes to the program outlined in QSO-23-01-NH  include:

      • CMS informed state survey agencies (SAs) to consider facility staffing levels data when selecting SFFs from the SFF candidate list. For example, if a SA is considering two facilities with a similar compliance history to be added to the SFF program, CMS recommends selecting the facility with lower staffing based on the 5-Star staffing rating or staffing ratio.
      • 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. Facilities will not be able to graduate from the program without showing systemic improvements made in quality.
        • Criteria for graduation from the SFF program includes 2 consecutive standard surveys with 12 or less deficiencies cited at scope and severity (s/s) level of E or less on each survey.
        • SFFs will not graduate if the following occurs: deficiencies cited at s/s level of F or higher on any standard survey; citations at s/s level of G or higher on any LSC or EP survey; 13 or more deficiencies on any survey (STD, LSC, EP, or complaint); intervening complaint surveys with 13 or more deficiencies or any deficiency cited at s/s level of F or higher; or any pending complaint surveys triaged at IJ, or Non-IJ High, or until it has returned to substantial compliance.
      • The program’s monitoring period is being extended. CMS will closely monitor SFF graduates for 3 years to ensure improvements are sustained. Harsh enforcement actions, up to, and including discretionary termination, may be imposed if a facility’s performance declines after graduating from the SFF program.
      • SFF with immediate jeopardy (IJ) deficiencies on any two surveys (STD, Complaint, LSC, or EP) will be considered for discretionary termination from Medicare and/or Medicaid program.
      • SFF will face more severe, escalating enforcement actions if they show continued noncompliance with “little or no” effort toward improving performance.
      • The monthly SFF public posting lists are being updated to reflect a listing of all SFFs, including the number of months spent in the SFF program, their most recent STD survey findings, recent terminations, and recent graduates of the program. SFF graduates are included on the list for 3 years. A SFF designation on the Care Compare website will be removed in the month following graduation from the SFF program.


Contact Proactive for information on clinical quality and regulatory compliance support services for Special Focus Facilities and facilities on the SFF Candidate List


Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC
Director of Regulatory Services

Learn more about the rest of the Proactive team.