Medical At Home
Webinar Playback: Medical-at-Home: A Game-changing Opportunity for Long-Term Care
What is it?
Providing long-term care services to patients who might otherwise be in a nursing facility without this care in their homes. The medical at home (MAH) model represents a shifting population of patients preferring to receive the same care they would receive in a long-term care (“LTC”) facility in their homes, which is a lower cost environment.
Who Is a Medical At Home Patient?
An MAH 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 healthcare professional may determine a patient’s level of acuity and deem the patient fit to receive medical 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
LTC pharmacies may additionally provide the below services to a patient in their home:
- Medication management services
- Medication Therapy Management (MTM)
- Medication reconciliation – discrepancies discovered are documented and corrected with current prescribers
- Medication synchronization
- Consulting services
- Medical chart reviews
- Transition of care management – pharmacists and healthcare professionals collaborate to evaluate hospitalizations and aim to decrease readmissions
- Physician, caregiver, and family engagement and education
- Nursing home services (in concert with other healthcare providers)
- Occupational and physical therapy
- Activities of daily life (ADLs) (toileting, transferring, eating, bathing, and dressing)
What Needs To Be Done?
Currently, payment for MAH services does not match the level of care being provided to patients. Appropriate payment for medical at home services is the number one advocacy priority of the NCPA LTC Division.
NCPA LTC Division asks that CMS recognize medical 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” (medical at home) at the same level as patient residence code “3” (nursing facility) or “9” (intermediate care facility/mentally retarded).
UPDATE: 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 Administration