Memorandum


To:		AHCA Members

From:		Lyn Bentley
		Director of Regulatory Services

Date:		November 6, 2007

Re:	CMS Publishes S&C Memorandum:  Improvements to the National Special Focus Facility Program for Nursing Facilities – Notice Requirements 


The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification Memorandum in which they revise the Special Focus Facility initiative in three key areas:
* Improved notification;
* Public notice; and
* Focus on Quality of Care & Quality of Life Deficiencies

Improved Notification
* Initial Notice – CMS emphasizes the importance of all governing bodies, owners and operators, in addition to the nursing home administrators, to be fully apprised of the status of the facility as a Special Focus Facility at the beginning of the period during which the facility is so designated. 
* Removal from Special Focus Facility Designation – When a facility has met the criteria for removal, the state agency will notify the facility and all governing bodies, owners, operators, and the administrator.

Public Notice

After a Special Focus Facility has had one survey as part of this initiative, and the facility fails to “significantly improve care,” their status as a Special Focus Facility will be made public on the CMS Web site with a link from Nursing Home Compare.  According to the memo:  “Significant improvement means that a Special Focus Facility is able to demonstrate that its practices have no deficiencies greater than “E” or have caused no Substandard Quality if Care.”  

Focus on Quality if Care and Quality of Life Deficiencies

Life Safety Code deficiencies have been removed from the formula used by CMS to calculate the Special Focus Facility candidate list.  However, Life Safety Code surveys must be completed with the same frequency as health care surveys (approximately every six months) and any Life Safety Code finding of actual harm on the most recent survey will preclude graduation from the Special Focus Facility initiative.
Effective Date

The changes in the Special Focus Facility procedures are to be implemented by the state agency for facilities currently on the list and for newly selected Special Focus Facilities, as soon as the state agency is able but no later than January 1, 2008.

Additional Clarifications

CMS computes a Special Focus Facility candidate list each quarter.  The computation is based on three years of survey history, the severity of deficiencies, and the number of deficiencies.  Complaint deficiencies are also included in the computation.  Each state selects its Special Focus Facilities from a list of approximately 15 eligible nursing facilities with the “worst compliance history” based on the computations performed by CMS.

The “accountable parties” that must be notified when a facility is placed on the list and when the facility has graduated from the list are:
* Administrator;
* Chairperson of the Governing Body or the full Governing Body (as identified on Survey and Certification documents); and
* Owners and operators: This must include the holder of the provider agreement.  If reasonably feasible for the state survey agency, the notification should also include other clearly identifiable owners (such as the owner of the building and land if separate from the holder of the provider agreements, and corporate owner(s) for chain-operated nursing homes).

The State Ombudsman Office and the State Medicaid Director must also be notified when a facility is placed on the list and when a facility graduates from the list.

When a Special Focus Facility has completed two standard surveys with no deficiencies above a scope and severity of “E,” and has no complaints with a scope and severity above an “E” during that time period, the nursing home is eligible for removal from the Special Focus Facility Initiative.

The entire memorandum is on the AHCA Members Only Web site under Facility Operations, Survey and Enforcement, Memorandums:  http://www.ahcancal.org/facility_operations/survey_certification/Pages/default.aspx.
If you have additional questions, please contact me at lbentley@ahca.org.