CMS Publishes Memorandum on Changes to Special Focus Facility Notification Process

VHCA (11/16/2007)

The Centers for Medicare & Medicaid Services (CMS) has issued a Survey and Certification memorandum to state Survey Agency Directors advising them of revisions to the Special Focus Facility (SFF) initiative in three key areas:  improved notification, public notice, and focus on Quality of Care and Quality of Life Deficiencies.  The notification process associated with the Special Focus Facility Initiative requires that the administrator, owners, and boards of directors receive notification of a facility designation as a “Special Focus Facility.” Additionally, the State Medicaid Agency and the State Ombudsman Office will be notified.   After a Special Focus Facility has had one survey as part of the initiative and the facility fails to “significantly improve care,” its status as a Special Focus Facility will be made public on the CMS Web site with a link from Nursing Home Compare.  When a Special Focus Facility has completed two standard surveys with no deficiencies above a scope and severity of “E,” and has no complaints with a scope and severity above an “E” during that time period, the nursing facility is eligible for removal from the Special Focus Facility Initiative.

Life Safety Code deficiencies have been removed from the formula used by CMS to calculate and determine the Special Focus Facility designation.  However, Life Safety Code surveys must be completed with the same frequency as health care surveys (approximately every six months) and any Life Safety Code finding of actual harm on the most recent survey will preclude graduation from the Special Focus Facility initiative.

Historically, the SFF program was initiated because a number of facilities consistently provided poor quality of care, but periodically instituted enough improvement in the presenting problems that they would pass one survey only to fail the next (for many of the same problems as before).  The SFF program identifies nursing facilities whose quality of care has consistently demonstrated failure to maintain compliance and a history of facility practices that have resulted in harm to residents (as measured by the most recent three State recertification surveys); ensures that SFFs are surveyed with twice the frequency as other nursing facilities; and assures that effective action is taken, during and after a structured period of three standard surveys (approximately 18 months).

The changes in the Special Focus Facility procedures are to be implemented by the state agency for facilities currently on the list and for newly selected Special Focus Facilities as soon as the state agency is able but no later than January 1, 2008.  For a copy of the Memorandum go to the AHCA website.