MTM in Long Term Care

Covered Services

Eligible patients who reside in long term care (LTC) facilities or other types of institutional living settings may be eligible for a limited menu of covered services. Confirm who is responsible for administering the patients' medications to determine which services can be provided for the patient. 

The following are Patient Adherence Consultations and Patient Education & Monitoring services that are not covered for patients who have nursing staff or another healthcare professional administering their medications:

• Adherence Needs Monitoring
• Adherence – Needs Check-in
• Adherence – Needs Check-in + 90-day Fill
• Adherence - Needs Check-in + 100-day Fill
• Adherence – Inappropriate Admin/Technique
• Needs Immunization
• Needs Lab Monitoring or Health Test
• Needs Medication Assessment
• Needs Medication Synchronization
• Needs Patient Education
• Needs Refill
• Needs Social Determinants of Health Assessment
• New or Changed OTC Therapy
• New or Changed Prescription Therapy
• New Therapy Consultation

Defining the Comprehensive Medication Review (CMR) in Long Term Care (LTC)

Outcomes and CMS expect CMRs in the LTC setting to meet the following professional service definition: interactive, person-to-person and real-time between the patient and/or other authorized individual and the pharmacist. 

Delivering CMRs in LTC

Who can provide the CMR?

• Pharmacist at the pharmacy that is dispensing the patient’s medications
• Consultant pharmacist affiliated with the dispensing pharmacy that conducts medication regimen reviews for the facility
• Pharmacists embedded within physician clinics or health systems

Who can receive the CMR? 

• If the patient is cognitively intact and able to discuss his/her medications, conduct the CMR with the patient. 

• If the patient is cognitively intact but unable to receive the CMR, document the reason why the recipient of the CMR was someone other than the patient by selecting one of these options in the designated field: 

• • Patient provided verbal authorization for recipient to receive the CMR 

• • Patient provided written authorization for recipient to receive the CMR 

• • Patient resides in Long Term Care (LTC) and LTC staff confirmed authorized recipient 

• • • Authorized recipient may be an authorized representative, caregiver or prescriber. 

• If the patient is cognitively impaired or unable to discuss his/her medications, conduct the CMR with an authorized representative. Authorized representatives include: 

• • Facility healthcare staff 

• • Patient’s family member 

• • Healthcare proxy, legal guardian, power of attorney 

• • Prescriber 

Who can receive the CMR?

• Ask nursing staff if the patient is cognitively impaired. 

• Document if cognitive impairment was determined by testing at the facility (BIMS, MMSE), documentation in patient chart or confirmation with healthcare staff or family member. 

Who should I contact?

• The patient, if possible
• Ask to speak to the nurse who takes care of the patient. Involve the patient in the CMR service to the extent possible. Other appropriate facility nursing staff for CMR offer and/or delivery include:
  • DON (Director of Nursing)
  • MDS (Minimum Data Set) Coordinator/Nurse
  • ADON (Assistant Director of Nursing)
  • Unit Manager/Charge Nurse
  • Floor Nurse

Monthly Medication Regimen Review (MRR) vs. Comprehensive Medication Review (CMR)

Sometimes the CMR can be confused with the Medication Regimen Review (MRR) in LTC, but these are two separate services that may be completed by the same or different providers.

Best Practices

• Attempt to conduct the CMR with the patient first if the patient is cognitively intact. 

• If the CMR needs to be completed with nursing staff, offer to schedule a time, especially if there are multiple CMR-eligible patients at the facility. 

• Prior to calling the facility or patient, verify the CMR can be delivered by phone by checking the Outcomes platform. 

• Check with facility nursing staff to see if prescriber recommendations can be faxed to the facility for the prescriber to review. Fax the recommendation with attention to the patient’s nurse or the nurse who was the CMR recipient, if applicable.