CMS Revises Special Focus Facility Program for Nursing Homes

Nursing homes have experienced increased scrutiny in recent years. In October 2022, Centers for Medicare & Medicaid Services (CMS) released a revised policy memo with heightened guidance for its Special Focus Facility (SFF) program for nursing homes.

Special Focus Facility Program

CMS, in conjunction with state agencies such as the Department of Health, requires regular inspections of nursing homes to confirm compliance with health and fire standards. If a nursing home does not meet these standards, they are cited with deficiencies. Deficiencies are common during inspections, but patterns of deficiencies or an increased number of deficiencies over three standard survey cycles will make a nursing home eligible for the SFF program.

Each month, CMS provides every state with a SFF eligible candidate list, based upon the Five Star Quality Ratings. Each state has a specific number of SFF slots that must be filled from the candidate list. The number of slots is calculated according to the nursing home population within that state. CMS provides five candidates for each slot the state is required to fill. Since the only factor used to calculate these slots is the individual state’s nursing home population, there can be significant discrepancies in SFF-eligible scores between states.

While a small percentage of nursing homes nationally are SFF eligible, inclusion in the SFF program has significant ramifications for nursing homes. It requires the nursing home to undergo comprehensive inspections at least once every six months with progressive enforcement until the nursing home either graduates from the SFF program or is terminated from Medicare or Medicaid.

Revisions to the Program

The recently announced revisions to the SFF program include increased inclusion criteria, more stringent graduation requirements, and harsher penalties for noncompliance as follows:

• SFF program criteria is expanded to include consideration of staffing levels as part of inspection compliance.
• Once a nursing home is part of the SFF program, CMS implements a threshold number of citations that prevent a nursing home from graduating and extend the program monitoring period.
• The enforcement remedies for continued citations will progressively escalate. These include financial penalties such as Civil Money Penalties (CMP) and Discretionary Denial of Payment for New Admissions (DDPNA).
• CMS now has discretion to terminate nursing homes from Medicare and/or Medicaid for any serious deficiency on any two surveys while included in the SFF program.
• Following graduation, former SFF nursing homes are closely monitored for an additional three years.

While inclusion in the SFF program can be a challenge, graduation from this program is possible with support and guidance. Buchanan Ingersoll & Rooney attorneys have experience counseling the healthcare industry on regulatory and compliance issues and are here to help.