Published: January 30, 2026 | By Dr. Kirk, DNP, MBA, MSN, RN, LNHA, QCP

The Centers for Medicare & Medicaid Services just changed everything for struggling nursing homes. On January 28, 2026, CMS released a bombshell revision to QSO-23-01-NH that fundamentally transforms the Special Focus Facility (SFF) program—and if your facility has compliance issues, you need to understand these changes immediately.

Falls Are Now Part of the SFF Selection Equation

The most striking change? CMS is now explicitly considering fall prevalence when selecting Special Focus Facilities.

If State Agencies are choosing between two facilities with similar compliance histories, they're directed to select the one with higher fall rates among residents. This isn't theoretical—it's official CMS policy, driven by the Office of Inspector General's recent report on the severity of nursing home falls.

What this means: Your fall data is no longer just a quality measure. It's now a factor in the most punitive enforcement program CMS operates.

If you're on the SFF candidate list and have above-average fall rates, your risk of selection just skyrocketed.

Two Immediate Jeopardy Citations = Potential Termination

Here's the new red line: Any facility cited with Immediate Jeopardy deficiencies on any two surveys while in the SFF program faces discretionary termination from Medicare and Medicaid.

This is cumulative. An IJ citation on a standard survey in March plus another IJ on a complaint investigation in September equals two strikes—and you could be out of the program entirely.

No more endless chances. No more prolonged stays in SFF purgatory. CMS has drawn a clear line: demonstrate improvement or face termination.

Graduation Just Got Significantly Harder

The new graduation criteria are crystal clear and stringent:

• Two consecutive standard health surveys with 12 or fewer deficiencies
• All deficiencies must be scope/severity "E" or less
• Zero tolerance for any "F" level deficiencies
• No complaint surveys with 13+ deficiencies or "F" citations
• No LSC/EP surveys with "G" or higher deficiencies

Plus, every facility that graduates enters a three-year monitoring period where CMS retains authority to impose enhanced enforcement—including termination—if performance declines.

CMS is done with "yo-yo" noncompliance. They want sustained improvement, not temporary fixes.

The "Good Faith Effort" Requirement

Throughout the revised policy, CMS emphasizes that facilities must demonstrate good faith efforts to improve. This includes:

• Regular engagement with Quality Improvement Organizations
• Hiring external consultants to support improvement
• Implementing evidence-based interventions
• Making measurable operational changes (leadership changes, increased staffing)

When CMS is deciding between severe remedies and continued monitoring, they'll evaluate whether you've genuinely tried to fix your problems or simply hoped they'd go away.

How to Protect Your Facility: The SMK Medical Approach

After 15+ years helping over 100 long-term care communities navigate regulatory challenges, I can tell you exactly what facilities need to survive the new SFF reality:

1. Conduct a Comprehensive Mock Survey Immediately

You cannot wait for CMS surveyors to identify your vulnerabilities. MockSurvey.com provides comprehensive mock surveys using actual CMS protocols, giving you the roadmap to fix problems before they become citations.

Our mock surveys specifically evaluate:

• Fall prevention programs (now critical for SFF selection)
• High-risk F-tags that generate "F" level scope/severity
• QAPI infrastructure effectiveness
• Documentation supporting good faith efforts

2. Implement Evidence-Based Fall Prevention

With falls now factored into SFF selection, every facility needs a validated fall prevention program. This includes:

• Standardized fall risk assessment (like the Morse Fall Scale)
• Individualized interventions based on risk factors
• Staff training and competency verification
• Post-fall investigation and analysis
• QAPI monitoring of fall rates and interventions

My doctoral research achieved an 86.6% reduction in falls using systematic assessment and intervention—and we can help you implement similar programs.

3. Build Continuous Survey Readiness with SurveyGuard

The revised policy explicitly states that survey timing "must be as unpredictable as possible." You can't prepare in the week before you expect surveyors anymore.

This is exactly why we're developing SurveyGuard—our AI-powered compliance intelligence platform that provides:

• Real-time monitoring of regulatory vulnerabilities
• Predictive analytics identifying citation risks before surveys
• Continuous compliance assessment eliminating survey predictability
• Documentation systems proving good faith improvement efforts
• Fall risk tracking aligned with the new SFF selection criteria

SurveyGuard transforms compliance from periodic panic to continuous readiness—exactly what the new CMS enforcement philosophy demands.

4. Document Everything

When CMS evaluates your good faith efforts, you need evidence:

• Consultant engagement records
• Training documentation
• QAPI meeting minutes showing systematic improvement
• Outcome data demonstrating progress
• Financial records proving investment in quality

SMK Medical helps facilities build the documentation infrastructure CMS demands when making enforcement decisions.

The Bottom Line: Sustained Compliance Is No Longer Optional

The January 28, 2026 SFF policy revision represents the most aggressive enforcement posture CMS has taken in years. Fall prevention matters more than ever. Graduation is harder. Termination is faster. Unpredictability is the strategy.

You can either react to this reality or prepare for it.

If your facility is on the SFF candidate list, already in the SFF program, or simply wants to avoid ever being there, you need expert guidance and systematic improvement—not hope and last-minute preparation.

Visit MockSurvey.com today to schedule your comprehensive mock survey and identify vulnerabilities before CMS does.

Join the SurveyGuard waitlist to access next-generation compliance intelligence when we launch.

Contact SMK Medical LLC for expert consultation on graduating from SFF or avoiding designation entirely.

Because in the new CMS enforcement era, sustained compliance isn't optional—it's survival.

About Dr. Kirk

Dr. Kirk is the Senior Consultant at SMK Medical LLC, a healthcare compliance consulting firm serving over 100 long-term care communities nationwide. He holds credentials including DNP, MBA, MSN, RN, LNHA, QCP, LSSGB, PAC-NE, and FACHCA, with over 15 years of healthcare administration experience. He is currently leading the developing SurveyGuard, an AI-powered compliance platform for post-acute care facilities.

Related Resources:

• Schedule a Mock Survey: MockSurvey.com
• Learn About SurveyGuard: SMK Medical
• Download the Full CMS Memo: QSO-23-01-NH REVISED 

Keywords: Special Focus Facility, SFF program, CMS enforcement, nursing home compliance, fall prevention, mock survey, survey readiness, Medicare termination, healthcare compliance, long-term care regulations, SurveyGuard