DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S Baltimore, Maryland 21244-1850 Center for Medicaid, CHIP, and Survey & Certification/Survey & Certification Group Ref: S&C-10-32-NH DATE: September 17, 2010 TO: State Survey Agency Directors FROM: Director Survey and Certification Group SUBJECT: Special Focus Facilities (SFF) Procedures Background – The Special Focus Facility program (SFF) focuses on nursing homes that have a track record of substandard quality of care. Although such facilities have sometimes incorporated enough improvement in the presenting problems to pass one survey, they have frequently manifested many problems on the next survey, often for many of the same problems as before. Such facilities with a ―yo-yo‖ compliance history rarely addressed the underlying systemic problems that were giving rise to repeated cycles of serious deficiencies. States recommend new SFFs from a candidate list that is provided by CMS Central Office (CO) on a monthly basis. Once selected as an SFF, the State conducts twice the number of standard surveys and applies progressive enforcement until the nursing home either (a) graduates from the SFF program orb) is terminated from the Medicare and/or Medicaid programs. Details of progressive enforcement process are presented in Section III of this memo.