On-Demand Webinar: New Year, New Measure: Making Sense of the Long-Stay Antipsychotic Re-Specifications-New Year, New Measure: Making Sense of the Long-Stay Antipsychotic Re-Specifications

Video Transcription

Video Summary

The webinar, led by Jessie McGill from APACN, focuses on the 2026 re-specification of the CMS long-stay antipsychotic medication measure, which now includes claims data alongside MDS data to improve accuracy in capturing antipsychotic use among nursing home residents. The measure, initially planned for October 2025, was delayed to the January 2026 Care Compare refresh, applied retrospectively from Q3 2025 data. The updated measure uses a hybrid approach incorporating Medicare and Medicaid claims (pharmacy and outpatient/physician claims) and MDS assessments to identify residents receiving antipsychotics.<br /><br />Key changes include new exclusion criteria based on continuous enrollment in Medicare Parts A, B, C, D, and Medicaid during defined look-back periods, as well as hospice status and specific diagnoses (schizophrenia, Tourette syndrome, Huntington’s disease) verified by both MDS and claims data. Exclusion windows range from quarterly to one-year periods depending on criteria. Importantly, no risk adjustment covariates are applied.<br /><br />The webinar emphasized complexities in enrollment status exclusions, outlined how numerator and denominator populations are defined, and stressed the importance of accurate MDS coding and physician documentation to support diagnoses for exclusions. Public reporting impacts, including delayed Care Compare refreshes and a rolling four-quarter reporting period influencing Five Star ratings, were discussed.<br /><br />Quality improvement recommendations include rigorous MDS audits, ongoing medication management focusing on transitions of care, collaboration with physicians and pharmacists to ensure documentation, and attention to gradual dose reductions. Participants engaged through polls and Q&A, gaining clarity on technical details, with plans to provide additional resources to address outstanding questions.

Keywords

CMS long-stay antipsychotic medication measure

2026 re-specification

claims data integration

MDS data

nursing home residents

Medicare and Medicaid claims

exclusion criteria

Care Compare refresh

MDS coding accuracy

Five Star ratings