MedicaidDocumentationMedium impact
Nursing Facility Bulletin 198: Audits of Antipsychotic Medication Use in Nursing Facilities
MassHealth·MA · Psychiatry, Geriatrics·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
MassHealth will begin conducting audits of antipsychotic medication use in nursing facilities twice yearly starting in calendar year 2026, requiring facilities to provide detailed medical records and documentation for selected residents who were prescribed these medications.
Action Required
Starting calendar year 2026: Nursing facility billing teams must ensure comprehensive documentation is maintained for all MassHealth members prescribed antipsychotic medications, including psychiatric consultation notes, informed consent forms, gradual dose reduction attempts, monthly pharmacy reviews, and individualized care plans. Facilities must be prepared to provide full medical records for audited members within audit timelines. Failure to maintain proper documentation or submit corrective action plans within 30 days of notice will result in MassHealth sanctions.