A Special Focus Facility (SFF) is a nursing home selected for additional CMS oversight because of a history of serious quality problems. Candidate status and active participation are different. We explain the current selection and graduation rules so your recovery plan is based on the published criteria rather than an assumed timeline.
Candidate listing and active selection
CMS uses inspection-history scores to identify a state’s candidate pool. The state selects facilities from that pool when an SFF slot is available; selection is not an automatic promotion of whichever facility has the highest score. Current CMS guidance also recommends considering the prevalence of falls.
The scoring methodology uses the last two standard health survey cycles and three years of complaint survey performance. CMS publishes the candidate and active lists. Check the facility’s certification number and the report date before drawing conclusions from a listing.
What active status changes
Active SFFs receive full onsite health inspections at least once every six months, with life safety and emergency preparedness surveys at least annually. CMS can apply progressive enforcement. Active participants do not receive overall or domain stars on Care Compare; a warning sign and unavailable ratings replace them. Candidate status does not by itself have that same rating treatment.
The graduation criteria
The current CMS posting requires two consecutive standard health surveys after selection, each with 12 or fewer deficiencies, all at scope and severity E or lower. Findings at F or above do not meet this graduation criterion. A general improving trajectory is not a published alternative graduation route.
CMS also identifies IJ findings on any two surveys during SFF participation as grounds for consideration of discretionary termination. Other enforcement requirements continue to apply. There is no universal 18-to-24-month grace period that protects a facility from earlier action.
What to prepare for the next review
- Confirm your current status with the state survey agency and review the written enforcement notices.
- Map recurring findings to underlying gaps in assessment, staffing, supervision, training or recordkeeping.
- Give each correction an owner, a completion date and a way to verify the change in practice.
- Use QAPI to review whether improvements hold between surveys and to identify resource needs.
- Keep evidence of completed work and agency correspondence together. Continue monitoring after graduation.
We recommend treating the published criteria as a planning reference and confirming facility-specific decisions with CMS and the state agency. Changing ownership, engaging a consultant or replacing a leader does not itself demonstrate that the cited problems have been corrected. None of those actions guarantees graduation.
Sources and applicability
We checked these sources on . This guide covers federal requirements for Medicare- and Medicaid-certified nursing homes. State licensing and assisted living requirements need a separate check. Use the current agency notice for your facility and involve the appropriate clinical or legal adviser for decisions.
- CMS Special Focus Facility program posting (opens in a new tab)
The document served when checked was updated August 2026. See the opening pages for selection, survey and graduation criteria.
- CMS Five-Star Technical Users’ Guide — July 2026 (opens in a new tab)
Inspection, staffing and quality measure methodology; overall rating and SFF exceptions.