The use of atypical antipsychotics in elderly nursing home residents with dementia continues to be a hot topic for the Centers for Medicare and Medicaid Services (CMS). Newly updated guidelines offer more guidance and criteria for when the drugs can appropriately be prescribed.

CMS warns against using antipsychotic medications “without an adequate rationale, or for the sole purpose of limiting or controlling behavior of an unidentified cause,” because doing so provides “little chance” of effectiveness and may cause complications that include “movement disorders, falls, hip fractures, cerebrovascular adverse events (cerebrovascular accidents and transient ischemic events) and increased risk of death.”

In addition to “generally” allowing use of antipsychotic medications to treat conditions other than dementia such as schizophrenia and schizo-affective disorder, CMS added seven other conditions and modified an eighth:

• Schizophreniform disorder
• Delusional disorder
• Mood disorders (e.g., bipolar disorder, severe depression refractory to other therapies and/or with psychotic features)
• Psychosis in the absence of dementia
• Medical illnesses with psychotic symptoms (e.g., neoplastic disease or delirium) and/or treatment related psychosis or mania (e.g., high-dose steroids)
• Tourette’s Disorder
• Huntington disease
• Hiccups (not induced by medications)
• Nausea and vomiting not associated with cancer or chemotherapy
• CMS has also broadened the scope of this focus area by categorizing four additional drugs as “atypical” antipsychotics in this recent update. The four drugs added to the “atypical” list are asenapine, iloperidone, lurasidone, and paliperidone.

Familiarity with CMS guidelines can ensure a skilled nursing facility’s ability to receive maximum reimbursement from CMS. Read more about the new guidelines.

To learn more about how to defend against medication error claims, talk to an expert at Excelas.