The long-stay antianxiety or hypnotic medication measure counts residents who received either class of drug in the 7 days before the ARD of their most recent assessment. It is on Care Compare, it isn’t in Five-Star, and both Texas and Florida score it.
Two measures, one set of items
CMS calculates two long-stay measures from the same checkboxes, and they are easy to mix up:
| Measure | Where it’s reported | Who is excluded |
|---|---|---|
| N036.03 Percent of residents who used antianxiety or hypnotic medication | Care Compare, iQIES reports. Scored by Texas QIPP and Florida QIP. | Life expectancy under 6 months (J1400) or hospice (O0110K1b) |
| N033.03 Prevalence of antianxiety/hypnotic use | iQIES reports only, for state surveyors | Schizophrenia, psychotic disorder, bipolar disorder, Tourette’s, Huntington’s, hallucinations, delusions, anxiety disorder or PTSD |
The difference matters. A resident with an anxiety disorder checked at I5700 is left out of N033, but still counts in N036, the measure on Care Compare and the one the states pay on.
“This measure is a state surveyor measure and is not part of NHQI. As such, it is not reported on Care Compare on Medicare.gov and is only available on the iQIES QM reports.”
What puts a resident in the numerator
“This measure reports the prevalence of antianxiety or hypnotic medication use (long-stay) during the target period.”
On the target assessment, N0415B1 (antianxiety) or N0415D1 (hypnotic) is checked. Column 2, the indication, plays no part in the measure. A resident with a well-documented reason for the drug counts the same as one without.
For N036.03, the resident is left out of the denominator when:
- life expectancy of less than 6 months is coded (J1400 = 1), or
- the resident received hospice care while a resident (O0110K1b = 1), or
- the resident isn’t in the numerator and N0415B1 or N0415D1 is dashed.
There is no risk adjustment.
The 7-day look-back, and when it clears
N0415 is checked if the drug was taken at any time in the 7-day look-back (or since entry, if that’s shorter). One dose is enough: a single PRN in the window checks the box. So does a dose given anywhere while the person is a resident, by any route, including the emergency room.
The measure looks only at the target assessment, the resident’s latest qualifying assessment. If the prescriber and team take a resident off the drug, it stops counting once a target assessment has a look-back with no dose in it. The drug decision is a clinical one. The MDS only records what was given.
A worked example. Resident B has a PRN order for an antianxiety drug and got one dose, four days before the ARD of the quarterly that is Resident B’s target assessment. N0415B1 is checked, and Resident B is in the N036 numerator. Resident B also has an anxiety disorder checked at I5700, so N033 leaves Resident B out. The surveyor report and Care Compare tell two different stories about the same dose.
Code the class, not the use
Most errors in N0415B and D come from coding a drug by why it was given rather than by what it is.
“Code medications in Item N0415 according to the medication’s therapeutic category and/or pharmacological classification, not how it is used. For example, although oxazepam may be prescribed for use as a hypnotic, it is categorized as an antianxiety medication.”
- A drug with two classifications is coded in both. Check the package insert, or ask the pharmacist, and keep a consistent reference so the coder can show the source.
- Supplements aren’t medications. Herbal and alternative products such as melatonin, chamomile and valerian root are not coded in N0415.
- Over-the-counter sleep aids aren’t hypnotics.
“Over-the-counter sleeping medications are not coded as hypnotics, as they are not categorized as hypnotic medications.”
The documentation that supports the code is the MAR for the 7 days, plus any record of a dose given outside the building while the person was a resident. When the MAR and the MDS disagree, fix it before the assessment is submitted.
How the states use it
- Texas QIPP scores N036.03 as Component 3, Metric 2 for state fiscal year 2027. See Texas QIPP, explained.
- Florida’s QIP scores it as one of its MDS measures, each worth up to 3 points. See Florida QIP, explained.
See your building’s antianxiety and hypnotic rate against the nation, free.
SuperQM scores both N036 and N033 from each resident’s latest assessment, so you can see who counts in each before the quarter closes.
