; and (ii) by adding at the end the following new subparagraphs: (D) Conversion to the low-rated facility program (i) In general On the same date that the Secretary implements the high-rated facility program under paragraph (12), the Secretary shall convert the special focus facility program under this subsection to the low-rated facility program. (ii) Regulations The Secretary shall carry out the conversion under clause (i) through notice and comment rulemaking. (iii) Additional requirements for the low-rated facility program In addition to the provisions that apply to the low-rated facility program through the conversion from the special focus facility program, the succeeding provisions of this subsection shall also apply to the low-rated facility program. (E) Participation Subject to the minimum participation requirement under subparagraph (C), the Secretary shall designate the lowest rated nursing facilities under the rankings under paragraph (11)(B) for participation in the low-rated facility program. (F) Progressive enforcement actions The Secretary, in consultation with States, shall utilize progressive enforcement actions, of increasing severity, to ensure facilities participating in the low-rated facility program meet the applicable requirements under this Act. (G) Enforcement for patterns of deficiency The Secretary may utilize enforcement actions specified in subsection (h)(2) to remedy patterns of deficiencies cited across multiple surveys. (H) Compliance assistance programs (i) On-site consultation and educational programming (I) In general The Secretary shall establish on-site consultation and educational programming for nursing facilities participating in the low-rated facility program with respect to compliance with the applicable requirements under this Act. (II) Entity The on-site consultation and educational programming described in subclause (I) shall be carried out by quality improvement organizations under part B of title XI or other independent organizations of a similar type that do not