CMS tightens antipsychotic monitoring

A nursing home can now get caught using an antipsychotic even if the drug never shows up on the facility’s own assessment form. In January 2026, the Centers for Medicare & Medicaid Services changed its long-stay antipsychotic quality measure to pull in Medicare and Medicaid claims and Medicare Advantage encounter data, not just Minimum Data Set entries. (cms.gov) That sounds technical, but the basic idea is simple: the old scorecard mostly trusted what the home reported about each resident, while the new scorecard also checks the billing trail. The Centers for Medicare & Medicaid Services said this respecified measure took effect January 1, 2026, and it was added to Nursing Home Care Compare on January 28, 2026. (cms.gov, cms.gov) The drugs at the center of this are antipsychotics, which are sometimes used for schizophrenia and other serious psychiatric illness but have also been used in nursing homes to quiet agitation. The Office of Inspector General said on March 19, 2026 that focused inspections found “alarming instances” of inappropriate antipsychotic use and failures by medical directors, pharmacists, and facility policies to stop it. (oig.hhs.gov) Older residents with dementia are the group regulators worry about most. The Office of Inspector General said antipsychotics are not approved to treat dementia and pointed again to the Food and Drug Administration warning that these drugs can raise the risk of death in those patients. (oig.hhs.gov) One complication is tardive dyskinesia, a drug-caused movement disorder that can look like lip smacking, tongue movements, blinking, or twisting that the person cannot control. Recent long-term-care guidance for clinicians describes tardive dyskinesia as a persistent risk in older adults exposed to dopamine-blocking drugs such as antipsychotics. (neurologyadvisor.com, oregon.gov) The Centers for Medicare & Medicaid Services tightened the survey rules before it changed the public score. In a March 10, 2025 memo, the agency said revised nursing-home survey guidance on chemical restraints and unnecessary psychotropic medication would be used on surveys starting April 28, 2025. (cms.gov) The rule change also moved psychotropic-drug oversight into a tougher section of the survey manual. A Centers for Medicare & Medicaid Services transmittal dated April 25, 2025 shows the agency revised F605, the tag for freedom from chemical restraints, and added drug-regimen language from pharmacy rules under that same tag. (cms.gov) That matters inside a facility because every antipsychotic order now has to survive two different tests at once. One test is clinical, meaning staff need a documented reason, monitoring, and attempts like gradual dose reduction when appropriate; the other test is statistical, because the same use now feeds a claims-checked public measure on Care Compare. (cms.gov, cms.gov) The exclusions got tighter too. The old measure excluded residents with schizophrenia, Huntington’s disease, or Tourette syndrome, and the new version still uses those diagnoses, but the Centers for Medicare & Medicaid Services now updates supporting code files and cross-checks more data sources when deciding who should be left out of the count. (cms.gov, cms.gov) This is not a small corner of nursing-home care. The Centers for Medicare & Medicaid Services’ own long-running antipsychotic tracking showed 23.9 percent of long-stay residents were receiving an antipsychotic in late 2011, and the national rate was still 14.6 percent in late 2018 even after years of reduction efforts. (cms.gov) So the practical fallout lands on software and workflow, not just prescribers. If a home wants to stay compliant in 2026, its electronic record has to catch consent, diagnosis support, gradual dose reduction reviews, side-effect checks such as tardive dyskinesia monitoring, and the documentation needed to match what claims data will show regulators later. (cms.gov, cms.gov, oig.hhs.gov)