Special Focus Facility (SFF) Program, Webpage, December 7, 2022 (Updated). https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/downloads/sfflist.pdf.


The Centers for Medicare & Medicaid Services (CMS) and State Agencies (SAs) inspect nursing homes on a regular basis to determine if they are providing the quality of care that Medicare and Medicaid require to protect and improve residents’ health and safety. When nursing homes do not meet CMS’ health care or fire safety standards, these instances are cited as deficiencies, and we require that the problems be corrected.

Most nursing homes have some deficiencies, with the average being six to seven deficiencies per standard health inspection. However, we have found that a minority of nursing homes have:

  • More problems than other nursing homes (about twice the average number of deficiencies),
  • More serious problems than most other nursing homes (including harm or injury experienced by residents), and
  • A pattern of serious problems that have persisted over a long period of time (as measured over approximately three years before the date the nursing home was first put on the SFF list).

Although such nursing homes may periodically institute enough improvements to correct problems identified on one inspection, significant problems would often re-surface by the time of the next inspection. Such facilities with a “yo-yo” compliance history rarely address underlying systemic problems that give rise to repeated cycles of serious deficiencies, which pose risks to residents’ health and safety. To address this problem CMS operates the SFF program.

See CMS, Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, October 2022. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/usersguide.pdf.

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