**GAO-10-197**                      Published: Mar 19, 2010. Publicly Released: Apr 19, 2010.                  

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## Highlights

CMS established the Special Focus Facility (SFF) Program in 1998 to help address poor nursing home performance. States select a subset of homes as SFFs from a list of the 15 poorest performing homes in each state, but the program is limited to 136 homes nationwide because of resource constraints. CMS guidance directs states to survey SFFs twice as frequently as other homes and to propose more robust enforcement, including termination, for SFFs that fail to improve within about 18 months. GAO was asked to (1) determine the factors states consider in selecting SFFs and how SFFs differed from other nursing homes, (2) evaluate CMS regional office and state adherence to program guidance and the program's impact on homes' performance, and (3) identify other strategies that have been used to improve poorly performing homes. In general, GAO's analysis used CMS data from 2005 through 2009 on SFFs and other homes as well as interviews with officials in 14 states selected based on the number of SFFs in each state and other factors.

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## Recommendations for Executive Action

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## GAO Contacts

John Dicken
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## Topics

Health Care

AccountabilityDisabilitiesElderly personsEvaluation criteriaHealth care facilitiesMonitoringNursing homesPerformance appraisalPerformance measuresPeople with disabilitiesProgram evaluationStandardsStrategic planningSurveysRisk managementTraining utilizationQuality improvementComplianceCorrective action