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CMS Hones In on Underperforming Nursing Homes with Tougher Oversight

Analysis  |  By Jasmyne Ray  
   December 07, 2022

The nation's poorest-performing nursing facilities will now be under increased scrutiny by the federal agency.

Keeping with the Biden-Harris administration's mission to improve the safety and quality of nursing homes, the Centers for Medicare & Medicaid Services (CMS) announced it will increase its monitoring of facilities with poor performance through a series of revisions to the Special Focus Facility (SFF) Program.

Eighty-eight nursing homes participate in the SFF Program, which is 0.5% of all nursing homes in the country. The Program was created to help nursing homes improve compliance and quality, however, some facilities have not been able to achieve the necessary standards to graduate from the Program, or they fail to sustain compliance.

The revisions will increase facilities' requirements for completion of the SFF Program and increase enforcement against facilities that do not demonstrate improvement. With these actions, the Biden administration aims to create accountability and improve quality of care and safety in the nation's nursing homes.

"Let us be clear: we are cracking down on enforcement of our nation's poorest-performing nursing homes," Xavier Becerra, Department of Health and Human Services secretary, said in a statement. "As President Biden directed, we are increasing scrutiny and taking aggressive action to ensure everyone living in nursing homes gets the high-quality care they deserve. We are demanding better because our seniors deserve better."

The four revisions to the SFF Program are:

  1. Program requirements will be strengthened, with the addition of a threshold that will prevent a facility from exiting based on total number of deficiencies cited. Facilities will no longer be able to "graduate" from the program without "demonstrating systemic improvements in quality."
  2. Facilities cited with Immediate Jeopardy deficiencies on two surveys may have their federal funding terminated.
  3. CMS will begin imposing more severe enforcement actions on facilities with continued noncompliance and making little progress to improve performance.
  4. To provide an incentive for improvements, CMS will extend the monitoring period for facilities in the program. Enforcement actions for facilities that decline in performance after graduating from the program will be imposed readily and progressively severe.

"People in this country's nursing homes deserve access to safe and high-quality care, and facilities that aren't providing that level of service need to improve their performance or face the consequences," Chiquita Brooks-LaSure, CMS administrator, said in a statement. "Poor-performing nursing homes have the opportunity to improve, but if they fail to do so, the changes we are making to CMS' Special Focus Facilities Program will hold these facilities accountable for the health and safety of their residents."

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 


The latest changes to the Special Focus Facilities Program target underperforming nursing homes to ensure improvements are made and maintained.

In addition to requirements for completing the program becoming tougher, facilities that don't improve will have their federal funding terminated.

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