​The January 2026 Care Compare refresh introduces a major change to the long-stay (LS) antipsychotic quality measure (QM) that will delay when the public sees quality-improvement efforts. In the spring of 2025, the Centers for Medicare & Medicaid Services (CMS) announced the inclusion of claims and encounter data in re-specifying the measure. Initially planned to launch in October 2025, the change was delayed until January 2026. This article explains the rationale for these changes, what is now required, and strategies for quality-improvement efforts. 

Why the Change? 

In the June 2025 memo, QSO-25-20-NH-Revised, CMS explained that the upcoming changes to the LS antipsychotic measure would address long-standing concerns about the accuracy and completeness of antipsychotic reporting. The inappropriate use of antipsychotic medications has been a focus of CMS quality initiatives for more than a decade. It’s now believed that reliance on Minimum Data Set (MDS) data alone has created blind spots. Back in 2021, the U.S. Department of Health and Human Services Office of Inspector General claimed that antipsychotic use might be underreported on the MDS, particularly when prescribing occurs outside the seven-day look-back window or when diagnoses such as schizophrenia are over-coded.

CMS noted that incorporating Medicare and Medicaid claims data and Medicare Advantage encounter data will strengthen the measure to reflect what occurs during the nursing home stay, not just what is captured on a single assessment. The agency stated that increased reporting is expected from this change: “The national percentage of residents receiving an antipsychotic is 14.64 percent under the existing measure. Under the new measure, this will increase to 16.98 percent due to the new measure’s inclusion of additional data, resulting in improved accuracy.”

What Changed? 

The LS Percent of Residents Who Received an Antipsychotic Medication measure that formerly used only MDS data has now been revised. It is the first measure that uses a hybrid approach, both MDS and claims data. Previously, this measure used only MDS data on the target assessment to identify if a resident received an antipsychotic medication during the seven-day look-back period. It excluded residents from this measure only if diagnosis coding indicated three specific conditions: schizophrenia, Tourette’s syndrome, or Huntington’s disease. This approach, commonly used for many other long term care QMs, looked at just a seven-day snapshot during the target period (e.g., the calendar quarter) to determine if a resident met the criteria. 

In contrast, the new measure incorporates pharmacy claims for an antipsychotic medication during the entire target period, as long as it was filled while the resident lived in the nursing facility. The new specifications also overhaul the exclusions that now consider the resident’s enrollment status in Medicare Part A, Part B, Part C, and Medicaid during the target period, as well as during the year before the target assessment, and, in some cases, the year prior to admission. If a resident is not continuously enrolled in the specified programs during those time frames, he or she will be excluded from the measure.

The measure still excludes based on the same three diagnoses—schizophrenia, Tourette’s syndrome, and Huntington’s disease—but now the diagnosis coded on the MDS must also be supported by claims data during specified time periods. However, when a resident has a diagnosis of schizophrenia, the time period used for supporting claims data depends on the resident’s age and when he or she was admitted to the facility. Lastly, CMS also added hospice as an exclusion, but it considers only claims data, not how the MDS is coded.

Change in Action

Contrary to its name, Percent of Residents Who Received an Antipsychotic Medication, the measure not only captures residents who received an antipsychotic medication; it also captures those who had the medication filled by a pharmacy.

Consider an LS resident who experienced an emergency and went to the hospital. The resident has dementia with behaviors, but the facility has been able to manage them without pharmacologic interventions. At the hospital, the staff administered an antipsychotic due to the behaviors, and it was ordered on the transfer sheets when the resident discharged back to the nursing facility two days later. 

If the nursing home staff was unable to discontinue this medication before it was filled by the pharmacy, the resident will trigger for this measure. This consequence occurs even if the resident never received the medication in the facility because it was filled “while a resident” and during the target period.

 Changes to Quality-Improvement Efforts

With this re-specification, quality-improvement efforts must shift from narrowly auditing MDS Section N to managing the entire use of medications across the resident’s stay. Facilities can no longer assume that accurate seven-day look-back coding equates to strong performance. Instead, the facility’s quality assurance and performance improvement must focus upstream, tightening medication reconciliation at every transition, especially hospital returns.

Facility teams should also establish a timely review process to identify newly ordered antipsychotics and streamline a routine with the physician to discontinue unnecessary medications before the pharmacy fills them. In practice, this change means monitoring pharmacy reordering activities during the target period to ensure that discontinued antipsychotics are not being refilled. Clinical leaders will need to work with physicians and/or psychiatrists to confirm that antipsychotics and the related diagnoses, such as schizophrenia, are reviewed during visits so they can be included on the claim. 

Facility leadership must also recognize that, under the new measure, timing matters more than intent. A single filled prescription can impact the facility’s rate, even when vigorous and responsible gradual dose reduction and discontinuation processes are in place. If the medication was filled during the calendar quarter, even if discontinued by the end of the quarter, the resident will trigger. Thus, the team will have to wait until the following quarter, when the resident did not receive an antipsychotic and the pharmacy did not fill it, to reap the rewards of their quality efforts.

Conclusion

The updated LS antipsychotic measure requires facilities to respond differently, not only by coding accurately, but also by managing medications more deliberately in real time. Because the measure now captures pharmacy fills across the entire quarter, facilities have to anticipate how prescribing decisions, transitions of care, and pharmacy workflows affect their results. Improvements may not show up immediately on Care Compare, even when staff have taken the clinically appropriate actions. Facility teams that adjust their processes now will be well prepared to see sustained improvement reflected in future quarters. 

Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, is senior curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). 

The American Association of Post-Acute Care Nursing (AAPACN®) champions innovation and transformation across the post-acute care continuum by enabling providers to deliver unparalleled care. Representing more than 18,000 post-acute care nurses and leaders in over 6,100 facilities nationwide, AAPACN provides industry-leading education, certification, and evidence-based resources that elevate quality of care and drive operational excellence. Learn more at AAPACN.org.