The facilities with the most points in a state then become candidates for the SFF program. The
number of nursing homes on the candidate list is based on five candidates for each SFF slot, with a
minimum candidate pool of five nursing homes and a maximum of 30 per State. SAs use this list
to select nursing homes to fill the SFF slot(s) in their state. Additionally, since a facility’s staffing
(staffing levels and turnover) is very important to residents’ care, CMS recommends that SAs
consider a facility’s staffing information when selecting SFFs from the SFF candidate list. See the
list of candidates in Table D below.
Once a state selects a facility as an SFF, the SA, on CMS’s behalf, conducts a full, onsite
inspection of all Medicare health and safety requirements every six months, and recommends
progressive enforcement (e.g., civil money penalty, denial of Medicare payment, etc.) until the
nursing home either (1) graduates from the SFF program; or (2) is terminated from the Medicare
and/or Medicaid program(s). While in the SFF program, CMS expects facilities to take
meaningful actions to address the underlying and systemic issues leading to poor quality.
Once an SFF graduates or is terminated, each SA then selects a new SFF from a monthly list
of candidates. CMS also informs candidate nursing homes of their inclusion on the SFF
candidate list in the monthly preview of the Five-Star Quality Rating System. The facility will
graduate from the SFF program once it has had two consecutive standard health surveys with
12 or fewer deficiencies cited at S/S of “E” or less on each survey (these surveys must have
occurred after the facility has been selected as an SFF). To avoid situations where a facility
remains an SFF for a prolonged period of time, CMS is establishing criteria that could result
in the facility’s termination from the Medicare and/or Medicaid programs. SFFs with
deficiencies cited at Immediate Jeopardy on any two surveys while in the SFF program, will
be considered for discretionary termination.
For more information on the SFF program, please see CMS memorandum QSO-23-01-NH.
How Can You Use This Information?
If you are considering admission to a nursing home included on this list you may want to:
• Visit the Care Compare website to view information about the nursing home’s star
ratings, staffing, quality measures, and inspection results (see
https://www.medicare.gov/nursinghomecompare/search.html).
• Visit the nursing home. Talk to staff, residents, physicians, and other families. Ask
the nursing home staff what they are doing to improve the quality of care for
residents in the nursing home.
• Call the SA (agency contact information is posted on Care Compare) to find out
more about the nursing home.
• If the nursing home is an SFF, look at the length of time that a nursing home has been on
the SFF list. This is particularly important if the nursing home has been an SFF nursing
home for more than 18-24 months since such nursing homes are closer to either
graduating (due to improvements) or ending their participation in Medicare and
Medicaid.
• Call your local State Ombudsman, Administration on Aging, and local groups to find
out more about the nursing home.
If you currently reside in an SFF nursing home, please know that this home is being closely
monitored and will be inspected twice as often as other nursing homes. You may also direct
any questions you have to the contacts above.