(AP) — The worst-of-the-worst nursing homes will face tougher penalties if conditions don’t improve at their facilities, the Biden administration announced Friday.

The intensified scrutiny on some nursing homes, where more than a million people are housed, comes nearly two years after COVID-19 exposed subpar care and extreme staffing shortages that had long festered in the facilities.

Nursing home residents have been significantly more likely to die from COVID-19; as of February, more than 200,000 nursing home staffers or residents had died from the virus.

President Joe Biden had promised during his State of the Union address in February to overhaul the nation’s nursing home system but some of those initiatives have yet to be implemented fully.

The new guidelines announced Friday will apply to less than 0.5% of the nation’s nursing homes. The facilities are already designated as a “special focus facility” because of a previous violation and are on a watchlist of sorts that requires the Centers for Medicaid and Medicare to monitor them more regularly.

Starting Friday, those nursing homes will lose federal funding if they receive more than one dangerous violation — rule-breaking that put residents at risk for harm. They will also be monitored for a minimum of three years. CMS will also consider staffing levels at the nursing homes when adding facilities to its watchlist. Currently, 88 nursing homes are on the list.

“Let us be clear: We are cracking down on enforcement of our nation’s poorest-performing nursing homes,” said Health and Human Services Secretary Xavier Becerra.

The agency is studying staffing ratios at nursing homes, with the aim of implementing requirements. The study is expected to be completed next year.

The administration also announced $80 million worth of grants that will be given to health care organizations, trade groups or labor unions to train and hire nursing staff. Organizations have until Jan. 6 to apply for the money.