Focus on FALLS - Revisions to the Special Focus Facility Program
Special Focus Facilities (SFFs) are facilities designated by the State because they are found to have more deficiencies than most nursing homes. These facilities must have on-site inspections no less than every six months, and enforcement actions can be imposed (e.g., civil monetary penalties, denial of Medicare payment, etc.) until the nursing home either graduates from the SFF program or is terminated from Medicare and/or Medicaid.
On January 28, 2026, CMS released QSO-23-01-NH which implemented a major change to SFF selection.
In this memo, CMS revised the focus for SFF selection to emphasize the prevalence of FALLS.
CMS recommends that if the State is considering two facilities for SFF selection with a similar compliance history, they should select the one with the higher prevalence of falls.
For the last three years, CMS has instructed States to select SFF Facilities based on Staffing Levels, but now CMS is shifting the focus to falls!
This is due to a recently released OIG report that highlighted the seriousness of falls in nursing homes.
The OIG found that Medicare-enrolled nursing home residents experienced more than 42,000 falls with major injury over a one-year period. These falls reduced residents’ quality of life and were costly for the Medicare program.
In addition, the OIG found that falls are significantly underreported, thus making CARE Compare an unreliable tool. The OIG found that 43% of Falls with Major Injury were not reported on the MDS!
To address this issue, CMS released a Technical Specification Report last November recommending the incorporation of claims data into the Falls with Major Injury QRP measure to improve accuracy; however, they have not yet proceeded with this.
As a reminder, Falls with Major Injury is also a Medicare VBP (Value-Based Purchasing) Measure and contributes to Five-Star Rating.
A nursing home’s falls data is accessible in iQIES in the MDS 3.0 Facility-Level Quality Measure report.
It is important that MDS coordinators pull these reports monthly and share them with the Rehabilitation Department.
It is also critical to identify fall risks and mitigate them before they occur.
Some risks of falls include: decreased balance, inappropriate assistive device, poor footwear, contractures, poor transfers, inability to make needs known, poor positioning, and generalized weakness.
The Rehabilitation Department plays a key role in implementing strategies to minimize falls and improve patient quality of life!
QSO-23-01-NH: https://www.cms.gov/files/document/qso-23-01-nh-revised-2026-01-28.pdf
OIG Report: https://oig.hhs.gov/documents/sar/11445/Fall_2025_SAR–508.pdf
Falls TSP Report: https://www.cms.gov/files/document/fmi-technicalspecificationsreport-nh.pdf
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