WASHINGTON – Senate Budget Committee Ranking Member Chuck Grassley (R-Iowa) is demanding answers from the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) about steps being taken to rein in the dangerous overprescribing of psychotropic medications in our nation’s nursing homes. According to a recent HHS Office of Inspector General report, from 2015 through 2019 the number of nursing home residents reported as having schizophrenia but lacking a corresponding schizophrenia diagnosis in Medicare claims and encounter data skyrocketed by 194 percent. The report followed concerns raised by Grassley and his colleagues in 2020. 
 
“Unfortunately, the recent report confirms my decades-long concern that nursing homes are misusing potent and potentially lethal psychotropic medications without the requisite diagnosis or oversight,” Grassley wrote in a letter to HHS and CMS this week.
 
Last year’s OIG report also highlighted systemic flaws with CMS’s long-stay quality measure that tracks the use of psychotropic drugs in nursing homes. Because the use of these drugs for certain medical conditions such as schizophrenia, Huntington’s Disease and Tourette’s Syndrome are excluded from CMS’s long-stay quality measure, nursing homes may be incentivized to misreport residents as having these medical conditions to improperly improve their star ratings. 
 
“This warrants exacting scrutiny given that CMS implemented the ratings tool to help families make a heart-wrenching decision: which nursing home to select for a vulnerable loved one,” Grassley wrote.
 
On January 18, 2023, CMS launched its own investigation into certain nursing homes that are misdiagnosing seniors with schizophrenia and treating them with dangerous antipsychotic drugs. However, Grassley noted that the agency’s intended actions fall short of solving this serious issue. 
 
“The memo, which purports to ramp-up enforcement actions, in reality gives bad actors ‘an out’ by allowing nursing homes identified as high prescribers the opportunity to forego an audit by admitting they have errors and committing to correct the issue,” Grassley continued.
 
“The OIG report and your agency’s memo call into question the effectiveness of CMS’s oversight and enforcement actions,” Grassley concluded. “It appears that even when nursing facilities are cited with psychotropic drug deficiencies, enforcement is rare. … While CMS has indicated that some of the OIG recommendations are underway, protecting our nation’s most vulnerable nursing home residents remains a top priority for my office.”  
 
The full text of the letter can be found HERE.  
 

 

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