Assess
Root cause review
We go through your last three years of surveys, complaints, and CMS-2567s to find the system failures that keep producing deficiencies.
Special Focus Facility support
Get your facility off the Special Focus Facility list, and keep it off
On the CMS Special Focus Facility list, or showing up on the candidate list? SMK Medical works onsite with your leadership team to fix the systems behind repeat deficiencies, so you can graduate from the program and avoid termination.
The stakes
What the Special Focus Facility program means for you
CMS places nursing homes with a long history of serious quality problems in the Special Focus Facility program. Each month CMS publishes the list of facilities in the program and a candidate list that states choose from.
Once you are in, the pressure is constant: standard health surveys about every six months, unpredictable timing, and enforcement that escalates with each failed survey.
- Standard surveys at least every six months
- Progressive enforcement: civil money penalties, denial of payment for new admissions, directed Plans of Correction
- Graduation requires two consecutive standard surveys that meet CMS’s criteria
- Under the 2026 revision, Immediate Jeopardy on two surveys can lead to termination review
- Graduates are monitored for three years after leaving the program
- Your status shows publicly on Care Compare
What we do
How we help Special Focus Facilities
Plan
Graduation plan
A written, survey-by-survey plan with owners, deadlines, and monitoring, built around CMS’s graduation criteria.
Fix
Onsite stabilization
Consultants in your building working beside your administrator, director of nursing, and department leaders, not just sending reports.
Prove
Mock surveys between surveys
Unannounced-style mock surveys between state visits so problems are caught before surveyors arrive.
Respond
Survey response
Immediate Jeopardy removal plans, Plans of Correction, and informal dispute resolution support when findings come in.
Sustain
QAPI that holds
Performance Improvement Projects and monitoring that keep corrections in place after graduation.
Prevention
Candidate list facilities: act before selection
If your facility appears on the candidate list, you are one state decision away from the program.
States choose new Special Focus Facilities from the candidate list when a slot opens. CMS has told states to weigh staffing and falls when choosing between similar candidates. The best time to change your survey history is now, before selection.
We start with a mock survey and a focused review of falls, staffing, and repeat tags, then build the corrections into QAPI so your next standard survey tells a different story.
FAQ
Frequently asked questions
What is a Special Focus Facility?
A nursing home that CMS has placed in its Special Focus Facility program because of a persistent record of serious quality problems. These facilities are surveyed more often and face escalating enforcement.
How often are Special Focus Facilities surveyed?
At least every six months for standard health surveys, with timing that is intentionally unpredictable.
How does a facility graduate?
By passing two consecutive standard health surveys that meet CMS’s graduation criteria, with no new serious findings in between, and returning to substantial compliance.
Can a Special Focus Facility be terminated from Medicare and Medicaid?
Yes. Facilities that do not improve face escalating enforcement, and under CMS’s January 2026 revision a facility with Immediate Jeopardy findings on two surveys while in the program can be considered for termination.
Can you help if we are only on the candidate list?
Yes. That is the best time to act. We start with a mock survey and a review of repeat deficiencies, falls, and staffing.
On the list, or close to it?
Talk to a senior consultant this week. We will review your survey history and tell you where to start.