LTC At Home

LTC Pharmacy at Home

LTC Pharmacy at Home Standards

The Alliance for Long-Term Care Pharmacy at Home convened an expert panel to describe the requirements of a pharmacy providing these services to a patient in their home, based on the CMS requirements outlined in their guidance manual for facility based patients. CMS issued the Long-Term Care Guidance on March 16, 2005 with the Medicare Drug Benefit implementation. This guidance document laid out 10 specific requirements that plans were obligated to provide for residents of LTC facilities. Long-term care pharmacy at home brings LTC facility-level of pharmacy care to individuals living at home. The Alliance has developed how these 10 requirements apply to long-term care pharmacy at home. It is the hope of the Alliance that these requirements, as outlined, became the standards by which pharmacy services to this patient population are evaluated.

The requirements are presented in two formats, in a paragraph form in which the CMS Manual language is italicized and the non-italicized items are the Alliance guidelines for pharmacies providing LTC pharmacy at home services. In the table version, the columns are clearly identified.

We hope that along with the criteria the Alliance has outlined for patient eligibility for these services, a comprehensive service for patients with long-term care levels of need can be effectively delivered in the home environment.

Rapid Relief Revenue: Medical At Home On-Demand Course

"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. 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

One-Pager: Policy Options to Support LTC Pharmacy At Home

Supporting LTC Pharmacy At Home: Who, What, Why, and How

Advocacy

Joint sign on letter to House and Senate leadership advocating for support for the Preserving Patient Access to Home Infusion Act (H.R. 4104/S. 1976) and greater access to home infusion in Medicare (November 2024)

House Ways & Means Committee
letter to CMS advocating for Medicare beneficiary access to LTC pharmacy services at home (September 2024)

Alliance for Long-Term Care Pharmacy @ Home letter to CMS advocating for Medicare beneficiary access to LTC pharmacy services at home (July 2024)

NCPA's LTC Division supports Alliance for LTC Pharmacy @ Home at HHS (September 2023)

NCPA's LTC Division supports Alliance for LTC Pharmacy @ Home at CMS (August 2023)

NCPA's LTC Division supports Alliance for LTC Pharmacy @ Home at White House  (July 2023)

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
Transition of care management – pharmacists and health care professionals collaborate to evaluate hospitalizations and aim to decrease readmissions
Physician, caregiver, and family engagement and education
Nursing home services (in concert with other health care providers)
- 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.

Other NCPA LTC Division Advocacy Efforts