CMS Could Release Monthly List of Special Focus Candidates After Senators’ Report

Federal officials could soon begin releasing a previously undisclosed list of underperforming nursing homes targeted for potential inclusion in the Special Focus Facility program, SNN has learned.

The Centers for Medicare & Medicaid Services’ (CMS) roster of “candidates” for Special Focus Facility status became public on Monday, when a bipartisan pair of senators released the list of more than 400 buildings as part of a larger report on nursing home safety.

“Given the interest in the Special Focus Facilities (SFF) program and the agency’s commitment to transparency, CMS is evaluating the possibility of releasing the list, which is updated monthly,” a spokesperson on Tuesday told SNN via e-mail.


CMS identifies 88 skilled nursing facilities for inclusion on the formal SFF list, which consists of buildings with a consistent pattern of serious health and safety issues. Officials cull that group from a larger pool of 435 nursing facilities, which the agency does not generally make public.

But Sens. Bob Casey and Pat Toomey of Pennsylvania — a Democrat and Republican, respectively — in March asked CMS to provide the full lineup of SFF candidates, which they then released to the public this week.

“While the vast majority of nursing homes provide high-quality care, there are some that are consistently failing to meet objective standards of adequacy,” Toomey said in a statement announcing the list. “To date, CMS has arbitrarily excluded from public disclosure a subset of these underperforming nursing homes. Moving forward, I hope CMS will give the public this particular list, as well as all relevant information about nursing home quality.”


The senators dubbed the candidate list a “secret document,” though the CMS spokesperson emphasized that it — along with the official group of SFF properties — doesn’t represent the sum total of its work regulating the nation’s more than 15,000 nursing facilities.

“The issue of nursing home quality is much bigger than the 400-plus candidate facilities for the available 88 Special Focus Facility slots noted in this most recent congressional report,” the spokesperson said.

In particular, the CMS spokesperson pointed to administrator Seema Verma’s repeatedly professed interest in skilled nursing oversight. Verma in April issued an order to review all nursing home regulations along with a five-part strategy for improvement that she laid out in a concurrent blog post — including the implementation of payroll-based staffing ratings, and streamlined guidance for state survey agencies when determining “immediate jeopardy” scenarios.

“CMS is not waiting, and not settling for the status quo: I have directed my team at CMS to undertake a comprehensive review of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes,” Verma wrote in the post. “America deserves nursing homes that ensure residents are treated with dignity and kept safe from abuse and neglect.”

The CMS spokesperson also noted that 2,900 facilities have a one-star health inspection rating — information that is available on the existing Nursing Home Compare website.

“CMS is holding nursing homes accountable through oversight and enforcement measures and striving for better transparency of nursing home quality,” the spokesperson said. “CMS empowers consumers, their families, and their caregivers by giving them the resources they need to make informed decisions.”

Provider groups respond

The two primary trade groups that represent nursing homes in the United States — the American Health Care Association (AHCA) and LeadingAge — responded to the senators’ report in separate statements Tuesday.

Beth Martino, senior vice president of public affairs at AHCA, asserted that the information in the Casey-Toomey release wasn’t new, and that families can use Nursing Home Compare for a full breakdown of any issues that an individual property may have.

SNFs that have been formally selected for inclusion in the SFF program have a special designation on their Nursing Home Compare page, with the exact star rating hidden until they are removed from the list. Casey and Toomey alleged in their report that some of the properties on the non-public candidate list had positive ratings, with nearly half reporting staffing or quality ratings of three stars or more.

“In addition, it’s important to spend time looking at the entire picture of a facility when making care decisions,” Martino said in an e-mail to SNN. “We recommend taking several steps to evaluate a facility, not looking at just one measure.”

Katie Smith Sloan, president and CEO of LeadingAge, used her statement to emphasize that some SFF buildings eventually improve and become quality options for residents and their families, while also generally applauding efforts to increase public awareness of nursing home safety issues.

“We support efforts to increase ease of access to and transparency around information regarding care of older adults; we believe that consumers should have as much information as possible on any provider they are considering for care,” Smith Sloan said.

The CMS spokesperson also thanked the senators for calling attention to the issue.

“CMS works closely with members of Congress on our oversight and enforcement efforts and appreciates the work of Sens. Casey and Toomey on this important issue of nursing home quality,” the spokesperson said. “Their report draws heavily on the publicly available information from CMS.”

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