Xavier Becerra

The Centers for Medicare & Medicaid Services today announced it is increasing its scrutiny of chronically low-performing nursing homes by revising its Special Focus Facility Program.

The agency said it will toughen requirements for completion of the program, increase enforcement actions and lengthen the monitoring period for facilities that enter the program. Showing its commitment to staff improvement, CMS also called on states to consider a facility’s staffing level in determining which facilities enter the SFF Program.

CMS described the changes as a way to “increase accountability of bad actors in the nursing home industry.” A particular complaint of regulators and others in the past has been poor facilities’ tendency to “yo-yo” on and off the list.

“Let us be clear: We are cracking down on enforcement of our nation’s poorest-performing nursing homes,” said HHS Secretary Xavier Becerra. “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.”

Friday’s action comes five months after Sen. Bob Casey (D-PA), chairman of the Special Committee on Aging, called for more oversight of the program in a letter to CMS.

“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,” Casey wrote at the time.

There are currently 88 nursing homes in the SFF program, with approximately 400 more on the candidate list. Facilities in the program are to be surveyed every six months — more than twice as often as for facilities outside the program.

Casey said that his committee’s investigation had found that about 20% of those on the list had gone longer than the six-month interval even after regular, standard surveys had restarted in August 2020 after the pandemic had interrupted normal routines.

He had also called for an expansion of the program, noting there also are about 400 additional SFF candidates that do not receive additional oversight “due to limited resources at CMS.”

Today’s revisions did not appear to add more facilities to the Special Focus ranks.

Instead, CMS announced the following changes:

  1. Making requirements tougher with tougher criteria for successful completion of the SFF Program. A new threshold prevents a facility from exiting based on the total number of deficiencies cited. CMS said there would be “no more graduating from the program’s enhanced scrutiny without demonstrating systemic improvements in quality.”
  2. More quickly terminating federal funding for facilities that don’t improve. CMS said it will consider all facilities cited with Immediate Jeopardy deficiencies on any two surveys while in the SFF Program for discretionary termination from the Medicare and/or Medicaid programs.
  3. Increasing enforcement through more severe, 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.

This is a developing story. Check back for more details.