The Centers for Medicare & Medicaid Services built a program to single out the worst-performing hospices for intensified survey activity, but as of this writing the program is not running. CMS paused implementation of the Hospice Special Focus Program (SFP) effective February 14, 2025, and the pause remains in effect. A hospice should not treat an inactive program as a closed question. The statute and regulation behind it are still in force, a revised version could restart with little notice, and the survey deficiencies, complaints, and quality scores that feed the algorithm keep accumulating regardless.
What the Special Focus Program Does
Congress created the SFP in Section 407 of the Consolidated Appropriations Act, 2021, which added the special focus program requirement to the Social Security Act, codified at 42 U.S.C. 1395i-6(b). The statute directs the Secretary to identify hospice programs that have substantially failed to meet applicable requirements and to survey each selected program not less than once every 6 months while it remains in the program. CMS finalized the implementing regulation, now at 42 CFR 488.1135, in the CY 2024 Home Health Prospective Payment System final rule, turning the mandate into a published scoring method and a defined path out of the program.
How CMS Selects and Scores Hospices
CMS combines four indicators into one score, and a higher score means poorer performance: the count of condition-level deficiencies cited across 11 hospice Conditions of Participation, including patient rights (42 CFR 418.52), infection control (418.60), and core services (418.64); the count of substantiated complaints; the hospice's most recent Hospice Care Index score, a ten-indicator composite built from Medicare claims; and a CAHPS Hospice Survey Index built from caregiver responses on pain management, timely help, willingness to recommend, and overall rating. The deficiency and complaint counts draw on three years of data; the most recent cohort used May 1, 2021 through April 30, 2024. Hospices in the highest 10 percent of scores become candidates, and CMS selects the 50 highest-scoring hospices as that year's participants, excluding any hospice already under separate enforcement action.
The Program Is Currently Paused
A coalition of hospice associations challenged the SFP rule on January 16, 2025, arguing it was arbitrary and exceeded CMS's statutory authority. CMS removed the SFP candidate and participant lists from its website and ceased implementation for calendar year 2025, effective February 14, 2025. CMS has not announced a relaunch date since. The pause reaches only the SFP's selection and reporting mechanism; a hospice's ordinary survey cycle, complaint investigations, and termination-for-cause exposure continue on their normal track.
The survey findings, complaints, and quality scores behind the Special Focus Program algorithm keep accumulating whether or not CMS is currently running the program.
What Selection Would Mean
A hospice placed in the SFP loses any accrediting-organization deemed status it held and is surveyed not less than once every 6 months. To complete the SFP, a hospice needs two SFP surveys within an 18-month window with no condition-level deficiencies and no pending complaint survey triaged at the immediate-jeopardy or condition level, or otherwise return to substantial compliance. A hospice that cannot meet those criteria can be considered for termination from the Medicare program under 42 CFR 489.53, and the selection list and score are public. The SFP is a survey-based track, separate from claims-based review: a hospice can also face a RAC audit or a Medicare audit defense matter over billed claims, where sample findings can be extrapolated into a full-period recoupment demand.
Why Early Legal Counsel Is Critical
It is critical that hospice providers promptly retain experienced healthcare defense counsel upon receiving a survey finding, a complaint investigation notice, or any CMS communication referencing the Special Focus Program, including while the program remains paused. Early legal intervention can protect the hospice's rights, ensure accurate responses to surveyors, avoid inadvertent admissions during a complaint investigation, and allow counsel to communicate with the state survey agency or CMS on the hospice's behalf. Delaying legal representation can significantly affect the outcome of a matter and expose the hospice to unnecessary risk. For more on timing, see When to Engage a Medicare Audit Attorney.
How Health Law Alliance Can Help
Health Law Alliance's hospice and home health audit defense attorneys represent hospices against enrollment revocations, payment suspensions, MAC, UPIC and RAC audits, and related False Claims Act investigations. Health Law Alliance's attorneys have overseen 2,000+ audits and handled 5,000+ matters, with 25+ years of experience. If your hospice has received a survey finding or any communication referencing the Special Focus Program, contact Health Law Alliance's hospice and home health audit defense attorneys for a free, confidential consultation.
