The Government Accountability Office (GAO) has issued a report entitled “Poorly Performing Nursing Homes: Special Focus Facilities Are Often Improving, but CMS’s Program Could Be Strengthened.” In this report, the GAO reviewed the factors states consider in selecting facilities for the Special Focus Facility (SFF) program, which targets nursing homes with severe and persistent quality of care problems, along with how CMS and states adhere to related program guidance and the program’s impact on homes’ performance. The GAO found that when selecting SFFs from CMS’s list of candidate facilities, state officials considered factors other than rank on that list, such as their own knowledge of each candidate’s circumstances. In addition, the GAO reports that some states did not consistently follow CMS’s basic SFF program requirements, such as the required number of surveys. Moreover, the GAO described CMS’s enforcement guidance as vague, which results in inconsistent interpretations. Most SFFs that “graduated” from the program showed significant improvement while in the program, although there were some facilities that did not sustain that improved performance after graduation. The GAO discussed a number of strategies CMS and states have used to improve nursing home quality of care. The GAO recommends that CMS take several steps to strengthen the SFF program, including (1) notifying homes that are on the SFF candidate list and seeking legislative authority to charge SFFs for the costs of conducting additional surveys.