Special Focus Program (SFP) Eligibility

The Hospice Special Focus Program (SFP) identifies the poorest-performing hospices for heightened oversight, including more frequent surveys. Eligibility and selection are algorithm-driven. Current status (as of August 2026): the SFP was finalized in the CY2024 Home Health rule, but CMS ceased implementation on February 14, 2025, the associated litigation was stayed on March 21, 2025, and CMS has not announced a resumption date.

CMS finalized the SFP in the Calendar Year 2024 Home Health Prospective Payment System final rule (CMS-1780-F), published November 13, 2023 ^[1]. A hospice is SFP-eligible if it is an active provider, has billed a Medicare fee-for-service claim within the past 12 months, and has hospice survey data or Medicare Quality Reporting Program data ^[2].

The algorithm scores each eligible hospice — a higher score indicates poorer performance — using survey and quality data: condition-level deficiencies drawn from 11 quality-of-care Conditions of Participation, substantiated complaints, the Hospice Care Index (from Medicare claims), and CAHPS Hospice Survey measures ^[2]. Hospices are ranked highest to lowest; the top 10 percent by aggregated score form the candidate subset, from which CMS selects the poorest performers in sequential order — up to roughly 1 percent of hospices annually, depending on available resources ^[1].

CMS published its first SFP cohort of 50 hospices on December 20, 2024, using a survey-findings window of May 1, 2021 through April 30, 2024 ^[3]. Effective February 14, 2025, CMS ceased implementation for CY2025 to further evaluate the program, and a Technical Expert Panel is developing a revised selection algorithm (https://hallrender.com/2025/02/17/hospice-update-cms-pauses-implementation-of-the-hospice-special-focus-program-for-calendar-year-2025/; https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos-states-and-cms-locations/overview-hospice-special-focus-program-sfp).

The SFP's algorithm inputs — condition-level deficiencies, substantiated complaints, CAHPS scores, and the Hospice Care Index — remain the same data that will drive whatever selection mechanism replaces the paused program, so the underlying metrics continue to accumulate regardless of program status. Landing in the top 10 percent by aggregated score means exposure to far more frequent surveys and a compressed path toward termination once the program resumes. Because CMS is rebuilding the algorithm and has not named a new cohort, the period before resumption is the interval during which condition-level deficiency correction and CAHPS performance improvement affect a hospice's position in the candidate pool.