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 Medicaid To States: Curb Psychotropic Drug Use

An Aug. 24 bulletin from the Center for Medicaid & CHIP Services (CMCS) informs states about tactics to address vulnerable populations’ overuse of psychotropic drugs. Specifically, CMCS defines vulnerable populations as foster care children and senior citizens afflicted with dementia.
Psychotropic drugs are dangerous because they affect the central nervous system and can alter a person’s personality and mood, the agency said; antidepressants and antipsychotics are classified as common psychotropic drugs.

“A 2011 report by the Health and Human Services (HHS) Office of Inspector General found that 22 percent of the atypical antipsychotic drugs were not administrated in compliance with the Centers for Medicare & Medicaid Services’ [CMS’] standards,” the bulletin says. “A CMS study found that over 17 percent of nursing home patients had daily doses exceeding recommended levels.”

CMCS expresses grave concerns that caregivers’ passive attitudes regarding psychotropic drugs could produce a negative impact on the health and lifestyles of people with dementia. Because these patients often struggle to communicate their emotions and pain levels, CMCS urges caregivers to better address their patients’ needs before prescribing them mood stabilizers that may be unnecessary.

“Caregivers must gain an understanding of what is driving these behaviors prior to initiating an intervention or treatment,” the bulletin says. “Sometimes these behaviors may result from an undiagnosed medical condition, an adverse reaction to medication, unmet physical need, or mental illness.”

State and federal Medicaid representatives met with CMS officials for a two-day summit in late August to learn more about implementing the Medicaid Drug Utilization Review (DUR) program, which monitors psychotropic drug use.

The DUR is conducted through Medicaid state agencies and works in two phases. In the first phase, state officials install an electronic monitoring system that tracks prescription drug claims and highlights problems such as incorrect drug dosage or duration of treatment, therapeutic duplication, or clinical misuse.

The second phase is simple maintenance; CMS asks states to continually monitor the system, address the evident problems, and work to resolve them.

CMS leaders agree that every state has room for improvement regarding its drug-monitoring efforts and urged them to both incorporate DUR and draft plans of action to better tackle the issues at hand.
The U.S. Government Accountability Office (GAO) advises HHS to consider enacting regulations that would require patients be thoroughly informed prior to consenting to the administration of psychotropic drugs.

CMS has created and posted examples of comprehensive psychotropic drug programs on its website ( to assist states in their redesign efforts.

“The Partnership to Improve Dementia Care in Nursing Homes: Rethink, Reconnect, Restore” is an initiative first launched by CMS last March. Together with long term care providers, caregivers, federal and state officials, advocacy groups, and residents, the project aims to protect long term care residents from overuse of psychotropic drugs.
CMS and its affiliates hope that the project’s positive influence will lower the national prevalence rate of psychotropic drug usage by 15 percent by the end of 2013.

“The partnership promotes the opportunity for the nation to rethink dementia care, reconnect with residents via person-centered care practices, and to restore good health and quality of resident life,” the bulletin concludes.

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