Sections 1819(f)(8) and 1919(f)(10) of the Social Security Act require CMS to run a Special Focus Facility program for nursing homes with a persistent record of noncompliance and poor quality of care. CMS memorandum QSO-23-01-NH, revised January 28, 2026, is the instruction to state survey agencies. The public list, with a short explanation for families, is the monthly posting on the CMS nursing homes certification page. The posting dated September 2026 is the Special Focus Facility program list with candidates.
CMS describes the homes this program is built for in that September posting. Most nursing homes have some deficiencies. CMS says the average is six to seven deficiencies per standard health inspection. A minority of homes have about twice that many, more serious problems, including harm, and a pattern that has lasted a long time, measured over about three years before the home was first put on the list. CMS calls the pattern "yo-yo" compliance: a home corrects what one inspection found, and serious problems are back by the next one. The program exists to force attention onto that pattern.
Candidates and homes already selected
The September 2026 posting says candidates are identified with the same kind of point system used in the health inspection domain of the Five-Star Quality Rating System. Results from the last two standard health survey cycles and the last three years of complaint survey performance are turned into points from the number of deficiencies and their scope and severity. More deficiencies, and deficiencies at higher scope and severity, produce more points. The homes with the most points in a state become candidates. The star-rating guide explains that point system, including the letters A through L.
The candidate pool is five homes for each Special Focus slot in the state, with at least five homes and at most 30. State survey agencies select a home from that list when a slot opens, and CMS approves the selection. The January 2026 memorandum says the agency must select within 21 calendar days of the slot opening. It also tells states, when two candidates have a similar compliance history, to consider the prevalence of falls. The September posting gives families the same recommendation in shorter form: falls are a serious quality signal, and states should look at them when they choose.
A candidate is eligible to be selected. A Special Focus Facility has already been selected. The data dictionary's Special Focus Status column uses the words CMS stores for each: "SFF", "SFF Candidate", or blank when the home is neither. Being a candidate is a public warning about the inspection history that produced the score. It is not the same designation as being in the program, and it does not by itself start the twice-a-year survey schedule described below.
What changes after a home is selected
Once a state selects a home, the survey agency, on CMS's behalf, conducts a full onsite inspection of Medicare health and safety requirements at least once every six months, and Life Safety Code and emergency-preparedness surveys at least annually. The January 2026 memorandum says the number of homes in the program, 88, follows the funding for that survey pace, about twice the frequency of other nursing homes. The monthly PDF is the roster. A funding figure in the memorandum and a name on this month's list are different documents, and the list is the one to read for a particular home.
The survey agency recommends progressively stronger enforcement, for example a civil money penalty or a denial of Medicare payment, until the home graduates or is terminated from Medicare, Medicaid, or both. The memorandum says remedies are imposed immediately, with no chance to correct first, when an SFF survey cites deficiencies at scope and severity F or higher on a health or complaint survey, or G or higher on a life-safety or emergency-preparedness survey. Later surveys that cite at those levels are supposed to bring a stronger remedy than the one before. Immediate jeopardy on any two surveys while the home is in the program is grounds for CMS to consider termination. The program does not replace the remedies the statute already requires of every nursing home, including a denial of payment for new admissions if the home is still out of compliance three months after the first findings, and termination if it is still out of compliance at six months.
Graduation, in the September 2026 posting, takes two consecutive standard health surveys with 12 or fewer deficiencies, each cited at scope and severity E or lower. Those surveys have to happen after the home was selected. CMS lists graduates for three years so people who have been following the home can see that it left the program. The posting says graduation is an upward trend against that home's own history. It is not a statement that the building has no problems left. A separate table lists homes that left Medicare and Medicaid, often because they closed, sometimes because they later seek to re-enter after showing they can meet federal requirements.
The posting warns that state agencies enter survey results on their own schedule. A lag between the inspection and the posted list is possible. CMS tells readers to treat the list with caution and to add what the long-term care ombudsman and the state survey agency know. The ombudsman program is the resident advocate in every state. The Administration for Community Living describes it at acl.gov. Ombudsmen do not inspect the home and do not work for it.
Star ratings are withheld for current participants
The September 2026 Technical Users' Guide says nursing homes that are current participants in the Special Focus Facility program are not assigned an overall rating or a rating in any domain. Care Compare shows a warning in place of the overall rating. QSO-23-01-NH says the same thing in the instruction to states: CMS does not display star ratings for these homes, and identifies them with an icon and text instead. The point of withholding the stars is to keep a summary number from softening a record CMS has already decided needs this program.
Footnote 18 in the data dictionary is the code for that situation. The dictionary sentence is: this facility is not rated because of a history of serious quality issues and is included in the Special Focus Facility program. On a facility page, a blank star with that footnote is the rating CMS published, which is no rating. Staffing hours, citation rows, and penalty rows can still be in the file. Read those. The missing stars are the signal, and the citations are the detail.
Candidate status is stored in the same Special Focus Status field, with different words. The users' guide withholds ratings from current participants. A candidate can still have stars. If the page shows stars and the status line says the home is a candidate, both facts are in the file. Use the stars as the star-rating guide describes them, and read the candidate designation as CMS's statement that the home's inspection score is among the worst in the state.
Where CMS publishes the list
The current list is a download on the nursing homes certification and compliance page. The September 2026 file is organized as four tables. Table A is homes in the program now, with the most recent inspection date, whether that survey met the graduation criteria, and how many months the home has been an SFF. "Met" means the latest standard survey met the graduation test and the home is on track. Graduation still requires two consecutive surveys. "Not met" means the home starts that two-survey sequence over. Table B is graduates. Table C is homes no longer in Medicare and Medicaid. Table D is the candidate list.
QSO-23-01-NH says the public list is updated monthly. A home can be selected, graduate, or leave the program between catalog releases. This site repeats the special-focus value CMS put in the Provider Information file with processing date September 1, 2026. It does not rebuild the monthly PDF. If you need the copy CMS posted this month, use the certification page, and use Care Compare for the display CMS is showing the public today.
How this site shows the field
Provider Information has one special-focus column. When it is filled in, the facility page prints "CMS special focus status" and the value, then the text of footnote 18. Read the value before you apply the footnote. "SFF" means CMS has the home in the program. "SFF Candidate" means the home is on the candidate list. Footnote 18's sentence is about homes that are not rated because they are in the program. The star cards above that sentence show whether CMS published a rating in this file.
The page does not compute a rank, and it does not decide which candidate a state should pick. Compare will line the home up with others in the city or ZIP code on the measures the provider file contains. For a current SFF, the overall star in that comparison will be empty when CMS left it empty. Open the facility page for the citations. The deficiency-tag guide explains the letters on those rows, including immediate jeopardy at J, K, and L.
What families can ask
The September 2026 posting tells families who are considering a home on the list to do five things. Look the home up on Care Compare, including inspection results, staffing, and quality measures. Visit, and talk with staff, residents, physicians, and other families. Ask what the home is doing to improve. Call the state survey agency. CMS posts those contacts on its survey-agency page and also points to the contacts on Care Compare. If the home is already an SFF, ask how long it has been on the list. CMS says a stay longer than 18 to 24 months means the home is closer either to graduating or to leaving Medicare and Medicaid. Call the long-term care ombudsman.
If you already live in one of these homes, or someone you love does, the posting says the home is being watched more closely and inspected twice as often as other nursing homes. Questions can go to the administrator, the survey agency, or the ombudsman. A useful question on a visit is specific: the last survey date on Table A, whether CMS marked it met or not met, and which tags were immediate jeopardy or actual harm. The guide to choosing a home is the longer list of what to look at in the building, including evenings and weekends.
Selection for this program is about the federal survey record. It is not a state license grade, and it is not a comment on every person who works in the building. It does mean CMS has judged the history serious enough to inspect more often, to escalate penalties, and, for homes already in the program, to take the star rating off the page.
Sources
- CMS nursing homes certification and compliance, which links the current Special Focus Facility list.
- Special Focus Facility program with candidates, September 2026.
- QSO-23-01-NH, revised January 28, 2026.
- September 2026 Technical Users' Guide, Special Focus Facilities and health-inspection scoring.
- Social Security Act section 1819(f)(8) and section 1919(f)(10).
- Nursing Home Data Dictionary, Special Focus Status and footnote 18.
- CMS state survey agency contacts and the Long-Term Care Ombudsman Program.
- CMS Provider Data Catalog, nursing homes, processing date September 1, 2026.