CMS announced a new proposed rule (CMS-3347-P) this week, and among many changes, such as the delay of Phase 3 implementation, are changes to the use of antipsychotic medication.
In the proposed rule, CMS states that “some nursing homes are circumventing the pressure to reduce antipsychotic drug use by seeking an appropriate diagnosis from a physician that would justify the use of these drugs for a resident, typically schizophrenia.” The proposal to revise 483.45(e)(4) and (5) would limit PRN orders to 14 days. Those order could be extended in accordance with the facility’s policy if their is rationale documented by the physician. This revision does not create a distinction between anti-psychotics and other psychotropic medications. The change would also add that a facility’s policy on the matter must address what circumstances allow for extensions of PRN orders, and that the facility take into consideration the individual resident need.
CMS rationalizes these proposed changes stating that they would simplify facility surveys and reduce obstacles for mental health professionals to provide care. Read the full proposed rule here. CMS is seeking comments until September 16.