The Centers for Medicare & Medicaid Services (CMS) has released a revised Special Focus Facility (SFF) Program policy memo QS0-23-01-NH and updated the monthly SFF posting. These revisions are meant to increase the requirements for completion of the program and enforcement for facilities that do not demonstrate improvement. A high-level overview of key changes made in the revised memo are as follows:
Adding staffing levels as a consideration for SFF selection: CMS has directed states to consider a facility’s staffing level when selecting facilities for the SFF program. CMS recommends if a state is considering two candidates with a similar compliance history, it should select the facility with lower staffing ratios/rating as the SFF.
Increased Criteria for Completion of the Program: CMS has added a threshold that prevents a facility from exiting based on the total number of deficiencies cited. To graduate from the program, facilities must complete two consecutive standard health surveys, with no intervening complaint, LSC, or EP surveys with 13 or more total deficiencies, or any deficiencies cited at scope and severity of “F” or higher.
Involuntary Termination: SFFs with deficiencies cited at immediate Jeopardy (IJ) on any two surveys (standard health, complaint, LSC, or EP) while in the SFF program, will now be considered for discretionary termination.
Increasing enforcement actions: CMS will impose immediate sanctions on an SFF that fails to achieve and maintain significant improvement in correcting deficiencies on the first and each subsequent standard health, complaint and LSC/EP survey after a facility becomes an SFF. Enforcement sanctions will be of increasing severity for SFFs demonstrating continued noncompliance and failure to demonstrate good faith efforts to improve performance.
Incentivizing sustainable improvements: CMS will closely monitor graduates from the SFF program for a period of three years to ensure improvements are sustained. For SFFs that graduate but continue to demonstrate poor compliance identified on any survey (e.g., actual harm, substandard quality of care, or IJ deficiencies), CMS may use its authority to impose enhanced enforcement options, up to, and including discretionary termination from the Medicare and/or Medicaid programs.