On January 28, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a revised memorandum updating its Special Focus Facility (SFF) program. The revisions build upon changes first announced in October 2022 and are intended to strengthen oversight of persistently poor-performing nursing homes, promote sustained compliance, and ensure continued focus on areas of resident safety. The revised guidance is effective immediately, and CMS directed that the information be communicated to appropriate staff within 30 days.
CMS noted that while the SFF program has helped many facilities improve compliance and quality, some facilities remain in the program for extended periods without sufficient progress, while others graduate only to later regress, commonly referred to as “yo-yo” noncompliance. Both scenarios place residents’ health and safety at risk and underscore the need for continued accountability.
The most significant change in the 2026 guidance involves how facilities are selected for the SFF program. In addition to health inspection performance, State Survey Agencies (SAs) are now instructed to place greater emphasis on the prevalence of resident falls when choosing facilities from the monthly SFF candidate list. When comparing facilities with similar compliance histories, CMS recommends prioritizing those with higher fall prevalence. Other factors, including complaint history and prior enforcement actions, may also be considered. This change follows the Office of Inspector General’s report highlighting the seriousness of nursing home resident falls and the importance of improving fall safety.
Graduation criteria remain consistent with prior guidance. Facilities are expected to demonstrate a good faith effort toward systemic change, which may include measurable operational improvements such as leadership or staffing changes, engagement with Quality Innovation Network–Quality Improvement Organizations, use of external consultants, or implementation of evidence-based interventions. CMS continues to allow discretionary graduation in cases where the only deficiencies preventing graduation are certain carve-out tags, including F812, F813, F814, or F884 (COVID-19 and respiratory illness reporting to CDC).
Enforcement provisions continue to include progressive remedies for continued noncompliance, less predictable survey timing to maintain oversight, and discretionary termination when warranted. State Agencies will conduct standard health surveys no less than twice annually, and complaint investigations will be completed at least once every six months, consistent with §1819(f)(8) and §1919(f)(10) of the Social Security Act. Limited-scope and extended-period surveys will be conducted at least annually or more frequently if determined necessary by the State or CMS.
Post-graduation monitoring remains a core component of the SFF program. Facilities that graduate continue to be monitored for three years to ensure sustained compliance, and those that regress during this period may face enhanced enforcement actions, including possible termination.
Access the memorandum here.
Compliance Perspective
Issue
CMS has revised its SFF program to strengthen oversight of persistently poor-performing nursing homes and promote sustained compliance. The 2026 revisions place greater emphasis on the prevalence of resident falls in selecting SFF candidates, continue three-year post-graduation monitoring, and maintain graduation criteria focused on systemic improvements. Facilities should review their current policies, training, and audit practices to ensure alignment with these updates and ongoing resident safety requirements.
Discussion Points
- Review and update policies and procedures to reflect the continued expectations for systemic improvements, graduation criteria, post-graduation monitoring, and ongoing oversight. Consider working with an external consultant to assess whether current policies adequately address falls prevention, complaint management, and prior enforcement findings.
- Train staff on ongoing survey readiness and fall prevention strategies. Med-Net Academy offers the course Falls Management, which reviews what to do when a resident falls, the components of a fall investigation, how to identify risk factors for falls, and how to utilize interventions to prevent falls and promote resident safety.
- Conduct focused audits to identify potential compliance gaps, especially in areas like falls, prior deficiencies, or complaint trends. Facilities may consider modified or targeted mock surveys with the guidance of a consultant to proactively address gaps before surveys occur.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*