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Recently, the Centers for Medicare & Medicaid Services  (CMS) announced that it was cracking down on poorly performing skilled nursing facilities (SNFs) by making changes to the “Special Focus Facility,” or SFF, program. 

The SFF Program was created to find the poorest-performing nursing homes in the country.  These facilities continue to be inspected roughly twice as often as all other nursing homes  ̶  no less than once every six months  ̶  and face increasingly severe enforcement actions if improvement is not demonstrated.

Facilities must pass two consecutive inspections to complete the Program. The changes announced last week enhance the process.

To be forced into this program, there are three major criteria:

  • The facility had more than two times the average number of deficiencies;
  • The facility had more serious problems than other nursing homes; and
  • The pattern of deficiencies has persisted over a period of time.

There are currently 88 nursing homes in the SFF program today.

We applaud the following changes:

  • Facilities can not “graduate” from the program without showing systemic improvements in quality;
  • Moving to terminate Medicare participation for facilities with certain deficiencies; and
  • Tracking facilities that have performance declines after leaving the program.

The link below from CMS shows the current facilities in the SFF program.

The list breaks SFF facilities into three categories:

  • New additions;
  • Not improved;
  • Improving;
  • Facilities that have graduated (12 months of improvement);
  • Facilities that dropped out of Medicare and Medicaid; and
  • A “candidate” list of facilities that may qualify for the program.

While this information is available to potential residents on the CMS Nursing Home Compare website, it does seem that a more proactive approach would be to require these nursing homes to notify potential patients of their status. It also seems that if only 88 of the over 15,000 skilled nursing facilities in the country are in the SFF program, the net may have been set too low.

Resources:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/SFFList.pdf

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Timothy Powell, CPA

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

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