Medicare part d long term care pharmacy requirements
"An Easy Guide to Identifying, Documenting, and Caring for Medical-At-Home Patients," with Paul Shelton and Bri Morris, sponsored by Compliant Pharmacy Alliance, is now available on demand. This webinar is packed with tips to get you started serving long-term care at home patients. Click here to access the recording, slides, and components needed in an attestation form under "Resources" and "Media." Happy learning!
The Alliance for LTC Pharmacy @ Home Coalition
NCPA’s LTC Division continues to advocate for LTC-at-home services. Most recently, we’ve worked with American Society of Consultant Pharmacists and Senior Care Pharmacy Coalition to form the Alliance for LTC Pharmacy @ Home Coalition.
Policy Documents
Advocacy
What is LTC at home?
LTC-at-home services are services for patients in their homes who might otherwise be in a nursing facility without this care. The LTC-at-home model represents a shifting population of patients preferring to receive the same care they would receive in a long-term care facility in their homes, which is a lower cost environment.
Who is an LTC-at-home patient?
An LTC-at-home patient remains “home-bound” and medical care is focused on “curing” the patient in his or her home. This is a population of community-dwelling adults and children having functional and/or medical impairments that prevent them from leaving their homes independently.
A health care professional may determine a patient’s level of acuity and deem the patient fit to receive LTC care at home even though he/she qualifies to be in a nursing home. Talk with your LTC GPO about best practices for determining and documenting a patient’s eligibility.
What services are provided?
In order to participate in Medicare Part D sponsor LTC pharmacy networks, Chapter 5 of the Prescription Drug Benefit Manual requires that the pharmacy have the capacity to provide the following minimum performance and service criteria:
- Comprehensive inventory and inventory capacity
- Pharmacy operations and prescription orders
- Special packaging
- IV medications
- Compounding/alternative forms of drug composition
- Pharmacist on-call service
- Delivery service
- Miscellaneous reports, forms and prescription ordering supplies[1]
LTC pharmacies may additionally provide the below services to a patient in their home:
- Medication management services
- Medication therapy management
- Medication reconciliation – discrepancies discovered are documented and corrected with current prescribers
- Medication synchronization
- Consulting services
- Medical chart reviews
- Occupational and physical therapy
- Activities of daily life (ADLs) (toileting, transferring, eating, bathing, and dressing)
What needs to be done?
Currently, payment for LTC-at-home services does not match the level of care being provided to patients. Appropriate payment for LTC-at-home services is the No. 1 advocacy priority of the NCPA LTC Division.
The NCPA LTC Division asks that CMS recognize LTC-at-home pharmacy services regardless of where the patient resides and issue guidance formally recognizing patient residence code “01” (home) with level of service “7” (LTC at home) at the same level as patient residence code “3” (nursing facility) or “9” (intermediate care facility/mentally retarded).
CMS issues medical-at-home guidance
In December 2021, CMS issued guidance to clarify that Part D dispensing fees can include additional costs for specialized services typically provided in the institutional care setting, such as delivery and special packaging, for enrollees residing in their homes with institutionalized level of care needs.
Read NCPA’s press release on the matter here.
Letters to the administration
Additional resources
Webinar Playback: Medical-at-Home: A Game-changing Opportunity for Long-Term Care
