CMS Ramps Up Nursing Home Quality Control Program

The Centers for Medicare & Medicaid Services (CMS) is ramping up a program that focuses on nursing homes with serious quality issues after a sequester-induced reduction, the Department of Health & Human Services announced in a recent memo.

Effective in April, CMS adjusted the number of designated slots and facility candidates so states can resume selecting and replacing nursing homes for Special Facility Focus designation. This follows a reduction to the number of SFF slots due to the budget sequestration that occurred in 2013.

“We are now re-building the program by a gradual increase in the number of SFF slots from its reduced base,” says CMS in a memo. “Later, we will also introduce additional methods to address persistently poor quality in nursing homes.”


The initiative targets nursing homes that have had a history of “serious quality issues” and are included in a special program meant to stimulate improvements in their care quality, CMS says.

SFF nursing homes must be visited in person by survey teams twice as often as other nursing homes, which typically works out to twice a year.

“The longer the problems persist, the more stringent we are in the enforcement action that will be taken,” CMS says in a document outlining the initiative. “Examples of such enforcement actions are civil monetary penalties or termination from Medicare or Medicaid.”


Most nursing homes have an average 6-7 deficiencies per survey that get corrected within a “reasonable” period of time. However, some nursing homes have more problems than others—about twice the average number—and those problems are more serious, including harm or injury to residents.

Additionally, the “special focus” nursing homes typically have a pattern of serious issues that has persisted over a long period of time.

There are three possible outcomes for nursing homes in the SFF program: improvement and graduation from the program; termination from Medicare or Medicaid; or a time extension. The outcomes are expected to take place around 18-24 months after the nursing home has been named an SFF.

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The April memo from CMS includes a table that lists the total number of SFFs currently enrolled in the program, adjusted to accommodate future changes in the initiative. States can designate SFF facilities immediately, or phase in those designations through July 31.

View the memo.

Written by Alyssa Gerace