Skilled nursing facilities are facing changes in CMS survey guidance regarding unnecessary use of psychotropic medications. CMS is closely monitoring the use of these medications, which can be considered chemical restraints, and is asking facilities to focus on behavior interventions to minimize use. CMS is emphasizing the importance of professional standards of practice and the role of the medical director in monitoring the use of these medications. The use of psychotropic medications, including antipsychotics, antidepressants, anti-anxiety drugs, and hypnotics, in elderly residents in nursing homes should be carefully monitored and documented by prescribing practitioners. These medications can have serious side-effects and should only be used for residents with a clear diagnosis of a mental health condition or medical condition. The use of non-pharmacological interventions should be attempted before resorting to psychotropic medications. CMS has requested that skilled nursing facilities develop multidisciplinary teams to monitor psychotropic medication use in their residents, due to concerns about unnecessary use, adverse effects, and lack of comprehensive assessments. CMS is also moving psychotropic medications to F605 in an attempt to highlight the importance of proper medication management that has the potential for chemical restraint effects. This episode focuses on why CMS is making this request and the risks associated with psychotropic medication use in the elderly. A follow-up episode will discuss the need for comprehensive assessments, behavior interventions, and chemical restraints as a result of inappropriate use of psychotropic medications.