The Centers for Medicare & Medicaid Services has published its November 2025 Special Focus Facilities (SFF) list, identifying 88 nursing homes nationwide with histories of serious quality issues. An additional 712 facilities appear on the SFF Candidate list, indicating they may be added to the program if performance does not improve.
Program Overview
The SFF program targets nursing homes with persistent patterns of poor survey performance for enhanced oversight. Facilities on the list receive inspections approximately every six months, compared to the standard 12-15 month cycle, and must demonstrate sustained improvement to graduate from the program.
Facilities that fail to improve face progressive enforcement, potentially including civil monetary penalties, denial of payment for new admissions, and ultimately termination from Medicare and Medicaid. Since the program’s inception, 27% of SFF facilities have been terminated from the Medicare program.
Geographic Distribution
The November list shows concentration of SFF facilities in certain states: Texas (12 facilities), California (9), Louisiana (7), and Illinois (6) have the highest numbers. CMS notes that SFF designation reflects individual facility performance and does not necessarily indicate statewide quality issues.
Notably, several states including Minnesota, Oregon, and Maine have no facilities on either the SFF or candidate list, reflecting strong survey performance across their nursing home sectors.
Consumer Implications
CMS encourages consumers to check the SFF list when evaluating nursing homes, as SFF designation indicates documented, persistent quality concerns. However, the agency notes that being on the candidate list does not necessarily indicate current poor care—rather, it signals that past performance warrants monitoring.
Families with loved ones in SFF facilities should request information about the facility’s improvement plan and monitor subsequent inspection reports for evidence of progress.