The Centers for Medicare and Medicaid (CMS) has a program called the Special Focus Facility (SFF) Initiative, whereby nursing homes that have a history of serious quality problems are on their SFF list in order to stimulate improvements in their quality of care. If the facility makes significant and sustained improvement in quality of care, it may be eligible to graduate from the list. If the facility fails to make significant improvements, it remains on the list until CMS either grants it an extension of time to improve, or terminates it from participating in Medicare and Medicaid, which generally leads to the facility shutting down due to lack of funding. Facilities that are placed on the Special Focus Facility List are generally considered to provide very poor care. There are two facilities in Tennessee that are considered Special Focus Facilities.