CMS Quality Measure & Antipsychotic Medication Rates: Jan. 2026
For nursing homes, reported rates of antipsychotic medication usage are likely to shift upwards in 2026. The reason? CMS has updated its methodology for the Long-Stay Antipsychotic Quality Measure, effective Jan. 1, 2026 (CMS memo, rev. Sept. 10, 2025). CMS describes the change as an effort to improve accuracy in the reporting.
The revised measure will incorporate additional data sources: Medicare and Medicaid claims and encounter data, adding to the existing MDS data that is already used in the measure. “The national percentage of residents receiving an antipsychotic is 14.64% under the existing measure. Under the new measure, this will increase to 16.98% due to the new measure’s inclusion of additional data,” explains CMS.
In the revised measure, exclusions from the calculation will receive scrutiny, and some may be disqualified. CMS will use additional data to validate exclusions for schizophrenia, Tourette syndrome, or Huntington’s disease. This is in response to what CMS describes as “the overreporting of schizophrenia diagnoses on the MDS” as a means to justify the use of antipsychotics.
As these changes take hold, some nursing homes may see their reported rates of antipsychotic medications rise. Findings derived from the revised Quality Measure will roll into the Five-Star Quality Rating System and the Nursing Home Compare website.
Quality Measure: critical steps
CMS F605 addresses the key ideas of keeping residents free from chemical restraints and preventing the unnecessary use of psychotropic medications. While CMS guidance for antipsychotics and other psychotropic medications has not changed since the 2025 revision, the use of broader data sources could lead to different results for some nursing homes.
How can nursing homes prepare for the revised Quality Measure? Here are some critical steps:
- Carefully review the guidance for F605 and involve all care teams.
- Ensure comprehensive assessment and diagnostic accuracy. It’s important to meet all criteria for a diagnosis.
- Conduct comprehensive medication reviews for each resident.
- Ensure that documentation provides a thorough record of a resident's care, from initial assessment through ongoing interventions.
- Before psychotropic medications are used, attempt nonpharmacological interventions.
- When psychotropic medications are used, attempt gradual dose reduction (GDR) and document findings and rationale for decision-making.
- Employ structured audits of antipsychotic use and documentation to identify gaps and areas for improvement.
CMS compliance: We’re here to help
Antipsychotic stewardship has been a hallmark of the GuideStar care long-term care model for years. For us, it’s fundamental to our mission: to enhance the quality of life for our shared patients by easing their suffering while actively promoting their safety, functionality, and dignity.
GuideStar’s neurology-forward clinical protocols for dementia and behavioral care are built to meet and exceed CMS standards. We ensure the proper steps in assessment, diagnosis, and ongoing care to comply with CMS guidance and documentation requirements. For our client partners in long-term care, GuideStar performs diagnostic and pharmacological audits, fully aligned with CMS Quality Measures. Our comprehensive approach to QM provides nursing home leaders peace of mind as the stakes on antipsychotic usage rise in 2026.
Uncertain about how the revised CMS Quality Measure will affect your organization? Concerned about the impact on your ratings and reputation? Feel free to reach out. We’re here to help.