Explanation Of CMS Special Focus Facilities Initiative

New York nursing homes can find themselves on the Special Focus Facility (“SFF”) list if they have: 1) More problems than other nursing homes (about twice the average number of deficiencies), 2) More serious problems than most other nursing homes (including harm or injury experienced by residents), or 3) a pattern of serious problems that has persisted over a long period of time (as measured over the three years before the date the nursing home was first put on the SFF list). Two New York nursing home facilities were added to the Special Focus Facility list due to the severity of quality of care problems found by CMS surveyors:

Loretto Utica Residential 1445 Kemble Street
Utica NY

Northwoods Rehab At Hilltop
1805 Providence Avenue
Niskayuna, NY
Northwoods Rehabilitation has been on the SFF list for over 35 months. Below please find a complete explanation of the Centers for Medicare & Medicaid Services (“CMS”) Special Focus Facility Initiative.

Background

CMS and States visit nursing homes on a regular basis to determine if the nursing homes are providing the quality of care that Medicare and Medicaid requires. These “survey” or “inspection” teams will identify deficiencies in the quality of care that is provided. They also identify any deficiencies in meeting CMS safety requirements (such as protection from fire hazards). When deficiencies are identified, we require that the problems be corrected. If serious problems are not corrected, we may terminate the nursing home’s participation in Medicare and Medicaid.

Most nursing homes have some deficiencies, with the average being 6-7 deficiencies per survey. Most nursing homes correct their problems within a reasonable period of time. However, we have found that a minority of nursing homes have:

• More problems than other nursing homes (about twice the average number of
deficiencies),
• More serious problems than most other nursing homes (including harm or injury
experienced by residents), and
• A pattern of serious problems that has persisted over a long period of time (as measured over the three years before the date the nursing home was first put on the SFF list).

Although such nursing homes would periodically institute enough improvements in the
presenting problems that they would be in substantial compliance on one survey, significant problems would often re-surface by the time of the next survey. Such facilities with a “yo-yo” or “in and out” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies. To address this problem CMS created the “Special Focus Facility” (SFF) initiative.

How the Special Focus Facility (SFF) Initiative Works

CMS requires that SFF nursing homes be visited in person by survey teams twice as frequently as other nursing homes (about twice per year). The longer the problems persist, the more stringent we are in the enforcement actions that will be taken. Examples of such enforcement actions are civil monetary penalties (“fines”) or termination from Medicare and Medicaid. Within about 18-24 months after a facility is identified by CMS as an SFF nursing home, we expect that there will be one of 3 possible outcomes:

(a) Improvement & Graduation: The nursing home graduates from the SFF program
because it has made significant improvements in quality of care – and those
improvements are continued over time;

(b) Termination from Medicare: The nursing home is terminated from participation in the
Medicare and Medicaid programs. While such a nursing home may continue to operate
(depending on State law), usually it will close once Medicare and Medicaid funding is
discontinued. In such a case the State Medicaid Agency (and others) will assist all
nursing home residents to transition to another residence that can provide a better and
acceptable quality of care. This may include a variety of possibilities, such as another
nursing home, a community-based setting, or apartment with good support services.

(c) Extension of Time: The nursing home is provided with some additional time to continue in the SFF program because there has been very promising progress, such as the sale of the nursing home to another owner with a much better track record of providing quality care.

Website Resources:

CMS Special Focus Facility Ceritification and Compliance, 2010.

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