Enforcement Remedies on Horizon for Non-Improving Late Adopters in Antipsychotic Medication Reductio

Posted on March 13, 2019 by Sue Boyd

Non-improving late adopters in the reduction in long-stay residents who were receiving an antipsychotic medication may soon be subjected to enhanced oversight and enforcement remedies, according to a notice from the Centers for Medicare & Medicaid Services (CMS).  

CMS and the National Partnership to Improve Dementia Care in Nursing Homes have seen a reduction of 38.9 percent in long-stay nursing home residents who were receiving an antipsychotic medication. Despite this success, approximately 1,500 nursing homes nationally, which includes 34 Minnesota care centers, were identified as late adopters. Late adopters are defined as care centers that had not improved their antipsychotic medication utilization rates for long-stay residents and had high rates of usage since 2011. 

CMS notified these care centers of this identification in December 2017 and set a goal for them to decrease antipsychotic medication use by 15 percent for long-stay residents by the end of 2019. With the support of state dementia care coalitions and stakeholders across the country, CMS has provided outreach, strong technical assistance, coordination, and revisions to the underlying long-term care requirements and survey processes.

CMS will expand its efforts by pursuing a two-pronged approach: 1.) enhanced oversight and enforcement actions and 2.) focus on outreach with corporations that own or operate significant numbers of late adopter facilities.

Enhanced Oversight and Enforcement Actions

As of January 2019, there are 235 late adopter care centers that have been cited for noncompliance with federal regulations related to unnecessary medications or psychotropic medications two or more times since Jan. 1, 2016, and that have not shown improvement in their long-stay antipsychotic medication rates. CMS has broken these into two subgroups: group one had three or more deficiency citations, while group two had two citations. 

If these care centers are determined not to be in substantial compliance with requirements for Chemical Restraints (F605), Dementia Care (F744), or Psychotropic Medications (F758) during a survey (e.g., recertification, revisit, focused dementia/schizophrenia, and complaint), they will be subject to enforcement remedies for such noncompliance. Remedies will include discretionary Denial of Payment for New Admissions. In addition, for group one facilities, remedies imposed will include a per-day Civil Money Penalty (CMP) starting on the first day of the survey in which tags F605, F744, or F758 are cited. CMP amounts will continue to be established using the CMP Analytic Tool.

Focus on Outreach

In addition to the new enforcement approach, CMS will seek opportunities to engage and collaborate with corporations that own or operate significant raw numbers of care centers identified as late adopters or a significant percentage of their sites identified as late adopters.

CMS will re-evaluate this enhanced oversight policy in approximately one year among all late adopter homes to determine appropriateness to continue and/or modify efforts.

We encourage you to visit the National Partnership to Improve Dementia Care in Nursing Homes website for resources on reducing unnecessary antipsychotic medication usage and person-centered care.