New Emphasis: Medications and Informed Consent

New Emphasis: Medications and Informed Consent
Robert C. Accetta
Caring for the Ages, May 2025; 26(3) pp 12-13
Outline
    Post-acute and long-term care providers are preparing with renewed vigilance for the revisions made to the Centers for Medicare & Medicaid Services State Operations Manual (SOM), Appendix PP, which become effective at the end of April 2025. I refer the reader to the advance copy, which has been available since November 2024 (https://www.cms.gov/files/document/qso-25-14-nh.pdf). Sections of the SOM, including the revised F605 tag, pertain to chemical restraints, psychotropic medications, resident rights, and consent for treatment, and F757 pertains to unnecessary drugs.

Renewed verbiage in the guidance emphasizes the concepts of residents’ autonomy and freedom to accept or decline proposed interventions for their care, which aligns with the person-centered care planning directives. The guidance reaffirms the duty of facilities and prescribers:

• To provide behavioral or nonpharmacological interventions.
• To have conversations with the residents or their representative about the benefits and risks associated with any proposed treatment or alternative available options.
• To document consent to the agreed-upon plan.

As this pertains to medications, disclosure about the risks, benefits, and warnings (including boxed warnings for antipsychotics) and consent to the proposed initiation or increase of a medication regimen are now of utmost importance.