Special Focus Facility Program Nursing Homes, 2013–2022

Why OIG Did This Review

Implemented by the Centers for Medicare & Medicaid Services (CMS), the Special Focus Facility (SFF) program is the nation’s flagship program to facilitate quality improvements in the poorest-performing nursing homes through increased oversight. This data snapshot provides a detailed look at the nursing homes that participated in the SFF program from 2013 through 2022 and how nursing homes move through the phases of the SFF program.

What OIG Found

• SFF serves a very small number of the worst-performing nursing homes.
• SFFs generally graduated from the program, and they were primarily for-profit and nonrural nursing homes.
• Infection control was the most common deficiency category leading to selection.
• SFFs continued to receive high-level deficiencies while in the program but fewer than at selection.
• From 2013-2022, 92 percent of SFFs (591 of 645) received 6,296 total complaint surveys while in the program.
• Twenty-six percent of complaint surveys with noncompliance had a deficiency of high scope and severity.
• Over half of all remedies that SFFs received were civil money penalty (CMPs) paid by nursing homes.
• Of the 429 nursing homes that entered and exited in 10 years, 96 spent more than 2 years (24 months) in the SFF program.
• In most States, SFFs’ average time to graduation was less than 2 years.
• Variation in slots impacts SFF at the State level.
• Within 3 years of graduating from the SFF program, 64 percent of nursing homes received a serious deficiency from 2013-2022.