What Is a Special Focus Facility — and How Do Nursing Homes Get Removed?

What is the SFF program?

The Special Focus Facility (SFF) program identifies nursing homes with a sustained record of poor performance — specifically, facilities that have had significantly more problems than average, more serious problems than average, and have demonstrated a pattern of non-compliance over time.

CMS uses a scoring system to rank every nursing home in the country. Facilities with the highest scores — indicating the poorest performance — are candidates for SFF designation. CMS selects approximately two facilities per state for the active SFF list at any given time.

How does a facility end up on the SFF list?

SFF designation is based on a weighted scoring system that considers:

• The number of deficiencies cited in recent surveys
• The severity and scope of those deficiencies
• Whether Immediate Jeopardy citations have been issued
• Whether the facility has repeat citations in the same F-tag categories
• The facility's history of compliance over the past 3 years

A facility doesn't end up on the SFF list after one bad survey. It reflects a sustained pattern of deficiencies that CMS considers serious enough to warrant additional oversight.

What happens while a facility is on the SFF list?

Being on the SFF list has significant operational consequences:

• Surveys occur approximately every 6 months instead of annually
• CMS enforcement remedies are imposed more quickly following each survey
• Civil Money Penalties accumulate faster and at higher rates
• The facility's SFF status is publicly visible on the CMS Care Compare website
• Potential denial of payment for new admissions following certain deficiencies

How does a facility get removed from the SFF list?

Graduating from the SFF list requires demonstrated, sustained improvement over multiple survey cycles. CMS requires that a facility pass two consecutive standard surveys without Immediate Jeopardy citations and with a substantially reduced deficiency rate before removing it from the SFF list.

This typically takes 12–24 months of consistent compliance. Facilities that fail to improve within the expected timeframe may face termination from the Medicare and Medicaid programs.

The SFF Candidate list

In addition to facilities on the active SFF list, CMS maintains an SFF Candidate list — facilities with scores high enough to qualify for SFF designation but not yet formally enrolled. Candidate facilities should treat their status with the same urgency as active SFF designation.