07/23/2026

Survey Tip of the Week: Medical Director Responsibilities

CMS has expanded expectations for the medical director's oversight of schizophrenia diagnoses and the appropriate use of psychotropic medications. 

Under F841 of the State Operations Manual, the medical director is responsible for coordinating medical care and ensuring resident care policies reflect current professional standards of practice. This includes discussing concerns with, and intervening as appropriate, when a physician or other practitioner provides care that is inconsistent with accepted standards—for example, assigning a new schizophrenia diagnosis or prescribing psychotropic medications without adequate clinical justification or adherence to professional standards.

Medical director’s responsibilities include: 

• Implementation of resident care policies, such as ensuring physicians and other practitioners adhere to facility policies on diagnosing and prescribing medications and intervening with a health care practitioner regarding medical care that is inconsistent with current professional standards of care.
• Participation in the Quality Assessment and Assurance (QAA) committee or assign a designee to represent him/her. (Refer to F868).
• Addressing issues related to the coordination of medical care and implementation of resident care policies identified through the facility’s quality assessment and assurance committee and other activities.
• Active involvement in the process of conducting the Facility Assessment.

If a deficiency has been identified regarding a resident’s care, the Long-Term Care Survey Process (LTCSP) instructs surveyors to also determine if the medical director had knowledge or should have had knowledge of a problem with care, or physician services, or lack of resident care policies and practices that meet current professional standards of practice and failed to get involved or to intercede with other physicians or practitioners to facilitate and/or coordinate medical care; and/or provide guidance for resident care policies.