CMS Increases Oversight Policies for Low-Performing Nursing Homes

The Biden-Harris Administration has updated oversight policies for the Special Focus Facility (SFF) program in an effort to improve the quality and safety of low-performing nursing homes.

“People in this country’s nursing homes deserve access to safe and high-quality care, and facilities that aren’t providing that level of service need to improve their performance or face the consequences,” CMS Administrator Chiquita Brooks-LaSure said in the press release.

“Poor-performing nursing homes have the opportunity to improve, but if they fail to do so, the changes we are making to CMS’ Special Focus Facilities Program will hold these facilities accountable for the health and safety of their residents.”

The SFF program identifies the poorest-performing nursing homes in the country and inspects them no less than once every six months to ensure they are improving care delivery. The facilities face significant enforcement actions if they do not demonstrate improvements. They must pass two consecutive inspections to exit the program.

Around 0.5 percent of all nursing homes in the country, or 88 facilities, currently participate in the SFF program, according to CMS.

The recent revisions will increase scrutiny and oversight of nursing homes in the program.

CMS has strengthened the requirements for allowing facilities to complete the program by adding a threshold that prevents a facility from exiting based on the total number of deficiencies cited. Nursing homes now must demonstrate systemic quality improvements before they can leave the program.

Facilities that receive Immediate Jeopardy deficiencies on two surveys while in the program will be at risk of losing federal funding and being terminated from Medicare and Medicaid. In addition, CMS is imposing more severe enforcement actions for facilities that have continued noncompliance and shown little or no effort to improve performance.

CMS is also extending the monitoring period to at least three years for nursing homes exiting the SFF program. CMS will continue to impose enforcement actions if the facilities’ performances decline during this time.

CMS will advise State Survey Agencies to consider a nursing home’s staffing level when selecting facilities to include in the SFF program, as staffing can largely influence care quality.

With these changes, CMS aims to incentivize facilities to promptly improve their quality and safety measures, allow the SFF program to oversee more facilities over time, and promote sustainability of nursing home improvements to ensure they do not regress after leaving the program.

The revisions build on President Biden’s commitment expressed in the State of the Union Action Plan for Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes. The Administration promised to strengthen scrutiny of poor-performing nursing homes in the SFF program, improve care for residents faster, and hold facilities accountable for improper and unsafe care.

CMS has also emphasized efforts that nursing homes can take to support quality improvement, such as engaging the CMS Quality Improvement Organizations and hiring external consultants to help with performance improvement.

The agency is encouraging nursing homes to make good-faith efforts coupled with evidence to make measurable changes that will improve quality, such as changes in staffing and leadership. CMS will consider these efforts when evaluating potential enforcement actions for noncompliance. Nursing homes with noncompliance and no evidence of trying to improve quality will be subject to more severe enforcement actions and penalties.

Nursing homes have been heavily scrutinized throughout the COVID-19 pandemic. The facilities have seen high death rates, significant COVID-19 case counts, and consistent staffing shortages.

In June 2022, CMS updated guidance on minimum health and safety standards that long-term care facilities must meet to participate in Medicare and Medicaid. The guidance addressed nursing home staffing concerns that may have impacted care quality.

The Biden Administration also proposed establishing a minimum staffing requirement for nursing homes. However, data from the American Health Care Association revealed that facilities would have to spend up to $10 billion per year and hire almost 188,000 nurses to comply with the requirement.