On October 21, the CMS issued revisions to the Special Focus Facility Program (“SFF”) for poorly-performing long term care facilities. SFF participants are surveyed at least once every six months and can receive progressive enforcement actions up to and including termination from the Medicaid/Medicare program. The revisions include requirements for state survey agencies to now consider a long-term care facility’s staffing level when selecting participants for the SFF program. Additionally, Facilities can now face discretionary termination from Medicare/Medicaid program if they receive two surveys with immediate jeopardy citations. The revisions were implemented immediately and will affect the 88 nursing homes currently participating in the SFF program.