Ongoing Advocacy on Antipsychotic Quality Measures

Recent national media coverage has renewed attention on the use of antipsychotic medications in nursing homes, including a March 6 Washington Post article that examined concerns about potentially inappropriate prescribing and CMS’s longstanding efforts to reduce antipsychotic use. Some of this coverage has prompted questions about whether federal policy changes are underway.

At this time, it is important to clarify that no new federal action or regulatory change has been announced or implemented by CMS. LeadingAge National has not received notice of any immediate revisions to antipsychotic quality measures, enforcement practices, or rating methodologies.

For several years, LeadingAge has been engaged alongside other national aging, clinical, and patient organizations in advocacy efforts focused on improving how antipsychotic use is evaluated in nursing homes. This work is conducted through Project PAUSE, an ad hoc coalition that seeks to ensure federal policies better distinguish between appropriate, clinically indicated prescribing and inappropriate use.

Through Project PAUSE, coalition partners have successfully advocated for Fiscal Year 2026 appropriations report language directing:

• The Food and Drug Administration (FDA) to re‑evaluate long‑standing antipsychotic “black box warnings,” and
• The Department of Health and Human Services (HHS), including CMS, to revisit antipsychotic quality measures to better reflect clinical appropriateness.

These efforts reflect longstanding advocacy and policy dialogue, not a recent shift in federal enforcement or oversight. Project PAUSE has also engaged CMS directly over multiple years to raise concerns about how current measures may unintentionally discourage appropriate, patient‑centered care.

Providers should view recent press coverage as part of an ongoing public discussion—not as confirmation of imminent policy change. LeadingAge will continue to monitor developments closely and provide updates if and when CMS signals concrete action.

According to a recent McKnight’s article, nursing home providers and pharmacy groups reacted with surprise and cautious optimism after a CMS spokesperson confirmed the agency is “actively reviewing the antipsychotic quality measure with the goal of supporting clinically indicated use while continuing to discourage inappropriate prescribing.” The spokesperson emphasized CMS’s continued commitment to evidence‑based, transparent quality measures but did not provide a timeline or details on potential changes.

McKnight’s reported that CMS declined to answer specific questions about how the review might proceed or when providers might see any relief from the antipsychotic measure, which remains one of the most challenging metrics affecting Nursing Home Care Compare ratings. Two sector representatives told McKnight’s they had recently participated in conversations with CMS staff, who expressed some openness to reevaluating the measure.

The publication also reported that Congress included report language in recent budget negotiations instructing CMS to better distinguish between appropriate and inappropriate prescribing in skilled nursing facilities. CMS told McKnight’s, however, that its review of the measure was already underway prior to the appropriations report and framed the effort as part of its routine quality‑measure review process.

McKnight’s noted that while nursing homes have significantly reduced antipsychotic use since 2012, providers continue to raise concerns about the tension between strict quality measure penalties and the clinical realities of caring for residents with severe neuropsychiatric symptoms. The article also highlighted provider frustration that newer antipsychotic medications some designed specifically for dementia‑related symptoms have not been accompanied by updated regulatory review or adjustments to quality metrics.

The McKnight’s report included perspectives from clinical leaders and national organizations aligned with Project PAUSE, including LeadingAge, the American Association of Post‑Acute Care Nursing (AAPACN), and the American Society of Consultant Pharmacists (ASCP). These organizations emphasized that they do not support inappropriate prescribing or chemical restraints, but continue to advocate for a more nuanced, patient‑centered approach to quality measurement.

Finally, McKnight’s underscored that while some stakeholders perceive “movement” at CMS, others remain cautious, noting that as recently as late 2025 the agency continued to publicly defend aggressive reductions in antipsychotic use as a top priority.

LeadingAge will continue to engage on this issue and will keep state affiliates informed of any confirmed federal actions.

Contact:  Carrie Mosley, cmosley@leadingageny.org, 518-867-8383 x. 147