Medicare and Medicaid News

Consult Pharm, Vol. 22, No. 4. (April 2007), pp. 355-361.

American Society of Consultant Pharmacists Guidelines Included in the Medicare prescription drug benefit (Medicare Part D) was a provision that sponsors of Medicare Part D prescription drug plans (PDP) provide a medication therapy management (MTM) program for "targeted beneficiaries." Medicare beneficiaries who reside in long-term care facilities also are eligible for Medicare Part D and these MTM services. Long-term care facilities encompass skilled nursing facilities and any medical institution or nursing facility for which payment is made for institutionalized individuals under Medicaid, as defined in section 1902(q)(1)(B) of the Social Security Act, and other payer sources. The design and implementation of MTM services for Medicare beneficiaries who reside in long-term care facilities is complicated because of the Centers for Medicare and Medicaid Services' (CMS) requirement of medication regimen review (MRR) for nursing facility residents. MRR is a broader, yet similar, competing clinical requirement. Moreover, it is newly defined, recently updated, and expanded in Appendix PP of the State Operations Manual (SOM) under "Guidance to Surveyors of Long Term Care Facilities." Changes to Appendix PP were effective December 18, 2006. The American Society of Consultant Pharmacists (ASCP) considers MRR and MTM to be distinct processes even though they share common goals regarding quality, safety, and cost-effectiveness. This document differentiates MTM services from MRR services and establishes guidelines by which MTM can be performed in the long-term care setting.