Seema Verma explains Special Focus Facility selection criteria

The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma outlined the Special Focus Facility (SFF) selection methodology in a May 3, 2019 letter to Senator Robert Casey, Jr. The letter, which is a response to an inquiry about the Special Focus Facility program and the public availability of the full candidate list for the SFF program, outlines the methodology for how a nursing facility ends up on the list. CMSCG provided information on the selection methodology in a March 2017 blog post, which you can read here for background. Senators Casey and Toomey recently requested and released publicly the full SFF candidate list.

Administrator Verma’s letter states:

  • Facilities are identified for the SFF program using the same methodology as the Health inspection domain on the Five-Star Quality Rating System. This methodology returned to its unfrozen state in April 2019 of three survey cycles being used for the rating. You can read about the April 2019 Nursing Home Compare and Five-Star Rating changes in this March 2019 CMSCG Blog post.

This means that achieving good survey outcomes is the best way for a facility to keep itself off the candidate list. More points = more likelihood of being added as a candidate.

  • The current total number of available SFF slots and candidates is based on the 2014 sequestration reduction that limited the number of SFF slots to 88 nationally and a maximum of 440 candidates. CMS issued a related S&C Memo in April 2013, which can be viewed here.
  • For each SFF slot, there are 5 potential candidates. These candidates are selected by CMS and sent to the Regional Offices (ROs) and State Agencies (SAs) for their recommendations on which facilities should be selected. The SA makes its recommendations and the RO approves.

If there are no available slots in a state, then no candidates are selected to be added to the program. However, don’t forget that the regulators’ expectation is that facilities will go through the SFF program and either graduate in 12-18 months or be terminated. This doesn’t leave much breathing room for facilities who have had poor survey outcomes over the course of their 3-year survey cycle since facilities on the SFF list are surveyed more frequently (every 6 months vs. 12-15) and will be eager to show improvement and give their spot on the list to another facility. Administrator Verma’s letter states that CMS is reviewing whether it is able to publicly make the candidate list available on a routine basis, and in a June 5, 2019 press release, CMS stated it will release this list. The availability of the SFF candidate list which will put increased scrutiny on nursing homes’ survey performance from media and consumers in addition to the already enhanced regulatory scrutiny.

Read Administrator Verma’s May 3, 2019 letter in full here.

Is your facility on the Special Focus Facility candidate list? Check out this CMSCG Blog post, “Help, my nursing home may end up in the SFF Program” to learn more about the lifecycle of the SFF program and see our 3-part series, “Special Focus Facilities 101.” If you’re looking to improve the quality of care and services being provided in your organization, a CMSCG Mock Survey/Quality Review can help improve your survey outcomes. Contact us to learn more about our regulatory compliance and quality improvement consulting services for nursing homes across the United States.

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