Revised memo: CMS released QSO-23-01-NH REVISED on January 28, 2026, updating the selection criteria for the Special Focus Facility (SFF) Program.

• CMS will now emphasize the prevalence of falls among the resident population as the focus area for selection. CMS noted that this action is being taken following the Office of Inspector General’s recent report, which highlighted the importance of improving fall safety.

Other changes: CMS is also reducing survey predictability for the SFF Program by shifting from surveys once every six months to no less than twice annually.

• Life Safety Code and Emergency Preparedness surveys will be conducted at least annually, or as determined by the state or CMS.
• Nursing homes are identified as SFF candidates based on their last two standard surveys, instead of the last three, which were previously used.
• CMS also noted that it is revising the monthly SFF postings on a different website.

Action for facilities: In response to the memo, consider these steps:

1. Make routine checks of your Internet Quality Improvement and Evaluation System (iQIES) Five-Star Preview Report because this is how CMS will notify SFF candidates about their inclusion on the list. Checking when it is time for a Preview Report to be loaded (typically about one week prior to when Nursing Home Care Compare refreshes) is recommended.

2. Review your current falls data, which is accessible in iQIES through the MDS 3.0 Facility-Level Quality Measure (QM) report, located under the QM report category. Additionally, the MDS 3.0 Facility Characteristics and MDS 3.0 Resident-Level Quality Measure Reports identify other data, including which residents are included in the fall measure calculations.

Previously, CMS considered a facility’s staffing when determining if it was an SFF candidate. Moving forward, CMS will use the prevalence of falls when selecting an SFF.

• For example, if a state agency is considering two SFF candidates with a similar compliance history, CMS recommends selecting the facility with the higher prevalence of falls among the resident population.

To help with falls reduction, ahcancalED offers a free six module Fall Prevention Guide.

• The guide covers a variety of topics such as regulatory requirements, falls education, and post-falls management.

For questions or concerns related to the memo or the SFF program, please contact DNH_Enforcement@cms.hhs.gov.