Reforming Special Focus Facility List

Let us be clear: We are cracking down on enforcement of our nation’s poorest-performing nursing homes. We are demanding better, because our seniors deserve better.

–HHS Secretary Xavier Becerra.

Special Focus Facility

CMS will revise the Special Focus Facility Program to help residents of chronically low-performing nursing homes. Facilities in the program are to be surveyed every six months — more than twice as often as for facilities outside the program. Currently only 88 nursing homes are in the SFF program. But at least 400 more are on the candidate list do not receive additional oversight “due to limited resources at CMS.” Unfortunately, the revisions will not add more facilities to the Special Focus ranks.

The requirements for completion of the program will toughen. CMS also called on states to determine if a facility’s staffing level is safe. Studies show minimum safe staffing requires 4.1 hours per patient day of direct nursing care by RNs, LPNs, and CNAs. CMS added guidance to ensure that staffing is adequate to supervise residents with mental, psychosocial and substance use disorders.

Sen. Bob Casey (D-PA) as chairman of the Special Committee on Aging called for more oversight of the program in a letter to CMS. Casey wrote:

“A review of standard surveys conducted at nursing homes in the SFF program appears to show that many of these facilities are not being surveyed as frequently as required by law.” 

New Reforms

CMS is emphasizing use of its Psychosocial Outcome Severity Guide to measure the impact or abuse or neglect. Recent revisions clarify types of abuse, what surveyors need to regulate and what they don’t, and how quickly states should respond to complaints of abuse potentially resulting in Immediate Jeopardy.

CMS announced the following changes:

1. Making requirements tougher for successful completion of the SFF Program. CMS said there would be “no more graduating from the program’s enhanced scrutiny without demonstrating systemic improvements in quality.”
2. Terminating federal funding for facilities that don’t improve. CMS said it will consider all facilities cited with Immediate Jeopardy deficiencies for discretionary termination.
3. Increasing enforcement through escalating remedies that have continued noncompliance and “little or no” demonstrated effort to improve performance.
4. Incentivizing sustainable improvements by 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.