Washington, D.C. — Federal regulators are taking a fresh look at one of the nursing home industry’s most contentious quality measures: the policy discouraging antipsychotic medication use in long-term care facilities.
The Centers for Medicare & Medicaid Services is reviewing its existing guidance “with the goal of supporting clinically indicated use while continuing to discourage inappropriate prescribing,” according to an internal email cited by The Washington Post. The report came Friday, and CMS had not publicly confirmed or elaborated on the review by the time of publication.
Congress Pushed for the Change
The review didn’t happen in a vacuum. Congress quietly inserted language into last month’s budget negotiations directing CMS to better distinguish between appropriate and inappropriate antipsychotic prescribing in skilled nursing policies. While described as non-binding, the instruction carries weight — and advocates say it reflects growing frustration with a measure that many in the industry consider outdated.
“Project PAUSE continues to press CMS to reform the long-stay measure as the current measure, now almost 15 years old, is not a validated measure for quality and does not distinguish between an antipsychotic used appropriately versus potentially inappropriately,” said Chad Worz, chief executive of the American Society of Consultant Pharmacists. “The measure is public and the information provided to the public does not fairly represent whether those medications are being used appropriately in individual nursing homes.”
A Measure Built for a Different Era
Nursing homes have sharply cut antipsychotic use since 2012, responding to years of audits, penalties, and star rating reductions. But critics argue the current quality measure hasn’t kept pace with how these drugs have evolved.
New medications specifically designed for patients with dementia — conditions that affect the vast majority of nursing home residents — have come to market without any review of outdated “black box” warnings or exemptions under the existing federal framework. Outside of nursing homes, antipsychotics are widely used to ease neuropsychiatric symptoms affecting an estimated 97% of patients with Alzheimer’s disease.
A white paper from Manatt Health and the Alliance for Aging Research made the case that the existing quality measure is actively discouraging clinically appropriate prescribing — not just the inappropriate kind.
This tension isn’t new. As recently as November 2025, federal officials defended limiting antipsychotic use as a top priority, saying practitioners already have “the flexibility to provide individualized treatments… that are appropriate and clinically indicated.”
What Comes Next
It’s unclear how far the review will go or what policy changes might result. CMS has yet to comment directly on the scope of the review.
What is clear is that nursing homes and the clinicians who care for residents living with Alzheimer’s and advanced dementia have been pushing for a more nuanced federal framework for years. Whether this review delivers that — or amounts to a procedural exercise — remains to be seen.
