Renew Membership / Join

Hospice Special Focus Program (SFP)

About the Hospice Special Focus Program 

The hospice Special Focus Program (SFP) was developed by the Centers for Medicare & Medicaid Services (CMS) to identify and improve the performance of hospice providers struggling to meet quality standards. As part of the 2020 HOSPICE Act, the SFP was intended to strengthen oversight, promote quality improvements, and ensure compliance among underperforming hospices. However, as the program has taken shape, numerous concerns have emerged regarding its implementation. These concerns, including reliance on incomplete data and the potential for unfair targeting of providers serving underserved communities, have spurred a series of legislative and stakeholder actions. The following timeline outlines the key events surrounding the development and evolution of the SFP: 

Special Focus Program Timeline of Events: 

1. February 2020: In response to calls from NHPCO, NAHC, and other industry stakeholders to strengthen program integrity and identify and improve the care being delivered by poor-performing hospices, The Helping Our Senior Population in Comfort Environments (HOSPICE) Act, led by Representatives Jimmy Panetta (D-CA) and Tom Reed (R-NY), is introduced. 

2. December 2020: The HOSPICE Act, was passed as part of the Consolidated Appropriations Act of 2021, mandating the creation of the Hospice Special Focus Program (SFP) to increase oversight for underperforming hospices and support quality improvements. 

3. December 2020: The HOSPICE Act was enacted, officially initiating the development of the SFP by CMS. 

4. September 2021: Representatives Panetta and Reed urged HHS to form a Technical Expert Panel (TEP) to ensure that the SFP aligns with the HOSPICE Act’s intent and improves compliance and enforcement mechanisms. 

5. July 2021: CMS proposes an initial Special Focus Program algorithm in the CY 2022 Home Health proposed rule. 

6. November 2021: CMS does not finalize its proposed Special Focus Program methodology in the calendar year (CY) 2022 home health final rule. Indicates need for further evaluation following stakeholder feedback and considers a technical expert panel to inform algorithm refinement. 

7. Oct – November 2022: CMS, via Abt Associates convenes a technical expert panel. Recruitment began in July 2022 following a 30-day call for nominations. A representative from NHPCO served on the TEP. Abt Associates publishes its final technical expert panel report in April 2023.  

8. June 2023: The Centers for Medicare & Medicaid Services (CMS) releases the CY 2024 Home Health Prospective Payment System Rate Update and Quality Reporting Program Requirements proposed rule outlining the algorithm for the SFP.  

9. August 2023: A coalition of hospice organizations, including NHPCO and NAHC, submitted a letter to CMS addressing concerns about the SFP algorithm, particularly its reliance on incomplete data and scaling problems. They called for changes to prevent incorrect classifications of providers. 

10. August 2023: The National Black Nurses Association (NBNA) raised concerns about the potential for the SFP to disproportionately impact hospices serving underserved and diverse communities due to over-reliance on Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data. 

11. August 2023: Both NHPCO and NAHC submitted formal comments to CMS urging a delay in the SFP’s implementation and requesting revisions to the algorithm. They proposed a pilot or preview period to ensure data accuracy and equity. 

12. October 2023: Representatives Van Duyne, Blumenauer, Wenstrup, and Panetta, write to CMS highlighting concerns that the algorithm would “not adequately identify hospices that are truly struggling with performance”1 and asked for more transparency into why “its proposed methodology… differed so drastically from that which the TEP recommended”. 

13. November 2023: CMS finalized the SFP as part of the CY 2024 Home Health Prospective Payment System Rule. The finalized rule includes an algorithm for determining admission to the SFP, requirements for surveys, processes for graduating from the SFP, and criteria for potential termination from the Medicare program. Concerns were raised by the hospice community regarding the potential impact of the SFP on providers due to reliance on metrics like the Hospice Care Index (HCI) and CAHPS Hospice Survey data. 

14. November 2023: NHPCO presented on the outcomes of the hospice and home health final rules for CMS on a Hospice News webinar which included discussion of the implementation of the SFP. 

15. December 2023: The NHPCO Podcast releases Season 2, Episode 7: CMS’ Special Focus Program, What We Know to discuss the org’s efforts to advocate for a revised SFP algorithm and what providers can do to get involved.  

16. January 2024: NHPCO hosted a webinar for members on the SFP and communications strategies for being prepared for the release of the bottom 10 percent list. 

17. April 2024: The Hospice Action Network (HAN) and NAHC contracted with McDermott+ to perform a technical analysis on the SFP algorithm and identify any areas of weakness or concern. 

18. May 2024: The GAO Report was published, highlighting key issues in the CMS survey system for hospice providers, such as overdue surveys, inconsistent standards across state and accrediting agencies, and the delayed implementation of enforcement tools mandated by the 2021 Act. 

19. June 2024: NHPCO presented on the SFP and proactive communications strategies during the annual Council of States meeting 

20. August 2024: NHPCO Podcast Episode released: Season 3, Episode 5: Regulatory and Legislative Miniseries | Hospice Special Focus Program 

21. August 2024: The McDermott Report was released which highlighted significant flaws in the SFP algorithm, particularly its reliance on incomplete and inconsistent data, which risks misclassifying hospice providers and disproportionately affecting providers operating in underserved communities.  

22. September 2024: A bipartisan group of Congress members – Representatives Blumenauer, Van Duyne, Panetta and Wenstrup, sent a letter to CMS and the OMB requesting revisions to the SFP. They criticized the use of outdated survey data and the inappropriate weighting of certain quality metrics, emphasizing the need to prevent the misclassification of high-quality hospices. 

23. October 2024: CMS is moving forward with its final SFP design, despite extensive opposition from the hospice community and Congress, who argue that the algorithm is flawed and risks undermining access to high-quality hospice care for millions of beneficiaries.

24. November 2024: Representatives Beth Van Duyne (R-TX) and Jimmy Panetta (D-CA) introduced the bipartisan bill H.R. 10097, the Enhancing Hospice Oversight and Transparency Act. This bill seeks to delay the SFP’s implementation, providing CMS time to address flaws in the program’s methodology and ensure it fairly identifies low-performing providers while protecting quality hospice programs from unwarranted penalties​.

25. November 2024: Alliance CEO, Steve Landers, MD, MPH publicly voiced concern regarding the SFP’s implementation as currently outlined through an op-ed, CMS’ Hospice List Will Put Patients in Harm’s Way— But It’s Not Too Late to Fix It.

26. December 20, 2024: CMS released its list of the initial cohort of 50 hospices selected for participation in its Hospice Special Focus Program beginning in 2025. CMS also generated a list of future SFP candidates but are not publishing the candidate list at this time. Instead, CMS shared the underlying data used to create both lists to allow for external review, in ‘an effort to ensure transparency in the process by which low-performing hospices are identified.’ The Alliance will continue to work closely with the Administration and Congress to advocate for a delay of the SFP program.

27. January 16, 2025: A lawsuit was filed by the Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice. The lawsuit challenges CMS’ implementation of the Hospice Special Focus Program (SFP) as unlawful and arbitrary. 

28. February 14, 2025: Effective February 14, 2025, CMS ceased implementation of the Hospice SFP so that CMS may further evaluate the program.

Members Only Resources

News & Updates
Research and Reports
In the Press


Whether you're a member of NHPCO or NAHC, you can still log in to your Member Portal to access everything that each organization offers. Login now »