LTC At Home Credentialing Service

• Maintain availability of medications not typically stocked in retail pharmacies to meet individual patient needs, such as liquid formulations of medications usually provided as tablets or capsules, IV medications (e.g., antibiotics), and other specialized drugs.
• Ensure sufficient stock to fulfill prescriptions and orders daily, with urgent orders delivered within four hours and new maintenance prescriptions filled within 24 hours.
• Over-the-counter (OTC) medications must also be available and appropriately documented in the patient’s medical record.

• Meeting Unique Patient Needs
  Long-term care patients often require specialized medications not typically available in retail pharmacies. Ensuring the availability of such medications allows pharmacies to provide timely, effective care tailored to the complex health needs of this population.
• Timely Medication Access
  Prompt access to medications is critical in the long-term care setting to prevent treatment delays that could lead to adverse health outcomes.
• Comprehensive Care Coordination
  Stocking a full range of prescription and over-the-counter (OTC) medications supports holistic patient care. Including OTC medications in the patient’s medical record ensures all aspects of their treatment are documented, reducing the risk of drug interactions and improving overall care coordination.
• Regulatory Compliance and Patient Safety
  Secure storage of medications, especially controlled substances, is mandated by federal and state laws to protect patient safety and prevent diversion. Adhering to these standards reflects a commitment to compliance and upholds trust in the pharmacy’s operations.
• Supporting the Long-Term Care Model
  Long-term care patients often face unique challenges, such as limited mobility or complex care regimens. By maintaining a comprehensive inventory and capacity to fulfill these needs, pharmacies play a vital role in supporting the goals of long-term care: enhancing patient quality of life, reducing hospital readmissions, and ensuring safe medication management in the home or facility setting.

• Ensure Pharmacy Software Readiness
  
  • Invest in pharmacy software capable of processing both electronic and written prescriptions seamlessly.
  • Regularly update software to stay compliant with evolving industry standards and regulations.
  • Train staff to use the software effectively to reduce processing errors and delays.
• Develop and Maintain Comprehensive Policies and Procedures
  • Create a tailored policy and procedure manual specific to your pharmacy’s operations. Include:
    • Prescription receipt and processing workflows.
    • Delivery protocols, including timelines for routine and urgent deliveries.
    • Detailed instructions for ordering and handling controlled substances.
  • Use available resources, such as sample policies from associations, as a starting point, but customize them to reflect your pharmacy’s unique needs.
  • Review and update policies regularly to ensure they meet current compliance standards.

• Ensuring Compliance with LTC Standards
  Long-term care settings require specialized pharmacy operations to meet the unique needs of residents. By adhering to pharmacy practice standards, pharmacies ensure that prescriptions are dispensed safely and appropriately, aligning with the regulatory and clinical requirements of the LTC population.
• Facilitating Efficient Prescription Processing
  LTC pharmacies often handle high volumes of complex prescriptions. Pharmacy software capable of accepting and processing both electronic and written prescriptions streamlines operations, reduces errors, and ensures timely delivery of medications, which is critical for patient safety and adherence.
• Establishing Standardized Workflows
  Clear policies and procedures are essential for ensuring consistency and reliability in pharmacy operations.

• Compliance Packaging Standards
  
  • All maintenance medications must be provided in compliance packaging, typically for a 30-day supply or less.
  • Oral solids, except for medications required to remain in their original containers, must be dispensed in compliance packaging.
• Available Packaging Options
  
  • Punch or Bingo Cards.
  • Multi-dose cards (containing multiple medications in each bubble).
  • Pouch or Pillow Packs, with options for single or multiple medications per package.
• Special Considerations for Non-Oral Medications
  
  • Products that are not oral solids, such as insulin, creams, ointments, and ophthalmic solutions, may need to be dispensed in supplies exceeding 30 days, depending on patient needs and medication stability.

• Enhanced Medication Adherence: Special packaging simplifies medication administration, reducing errors for caregivers and patients.
• Improved Safety: Compliance packaging minimizes the risk of dosing errors, particularly in LTC at home settings where patients often experience polypharmacy.
• Customized Solutions: Tailored packaging options address the unique needs of LTC patients.
• Regulatory Compliance: Meeting packaging standards is critical for LTC pharmacies to align with state and federal guidelines, as well as contractual obligations with LTC’s level of service.
• Operational Efficiency: Utilizing standardized packaging formats streamlines pharmacy operations and supports effective medication delivery systems.

• Flexibility Through Subcontracting or In-House Capabilities
  Pharmacies can meet this requirement by:
  
  • Subcontracting or arranging services with another pharmacy, a hospital, a home infusion provider, or a specialized IV services pharmacy.
  • Preparing IV medications in-house, which may include:
    
    • Using prepackaged products that do not require preparation in a clean room.
    • Installing a clean hood or establishing a clean room within the pharmacy to prepare IV medications on-site.

• Critical for Complex Care Needs
  Many LTC patients require IV medications for acute treatments, such as antibiotics, hydration, or pain management, which are vital for maintaining their health and avoiding hospitalizations.
• Ensuring Patient Safety and Compliance Access to specialized facilities or vendors ensures IV medications are prepared and delivered in compliance with stringent safety and regulatory standards.

• Establish In-House Compounding Capabilities for Basic
  Modifications/Compounds
  
  • Equip the pharmacy with tools and materials for basic compounding, such as tablet splitters, crushers, and suspension equipment.
  • Train pharmacists and technicians on proper compounding techniques and regulatory requirements.
  • Implement workflows to ensure quality control and accurate documentation for all compounded medications.
• Subcontract with a Compounding Pharmacy
  • Partner with a compounding pharmacy or provider specializing in alternative drug formulations.
  • Ensure that subcontracted providers meet all regulatory and safety requirements.
  • Maintain clear agreements outlining roles, responsibilities, and quality expectations.

• Enhances Patient-Centered Care
  Many long-term care patients have unique needs that prevent them from taking medications in standard forms. Compounding ensures these patients can safely and effectively receive their prescribed treatments.
• Supports Medication Adherence
  Providing medications in a form that is easier for patients to take reduces barriers to adherence, improving therapeutic outcomes.

• Availability of Pharmacy Services
  A pharmacist must be accessible to patients, caregivers, and providers 24 hours a day, 365 days a year, to address medication-related inquiries or urgent needs.
• After-Hours Communication
  The pharmacy must have a dedicated phone service to manage after-hours calls, ensuring they are answered promptly and appropriately.
• Flexible On-Call Arrangements Pharmacist availability can be achieved through:
  
  • Employing on-call pharmacists, though this may involve higher costs.
  • Subcontracting with a backup pharmacy or pharmacy network to handle after-hours medication dispensing and emergencies.

• Immediate Access to Expertise
  Long-term care patients often face urgent or complex medication needs that require immediate consultation with a qualified pharmacist.
• Supports Emergency Medication Needs
  Providing after-hours dispensing ensures that patients receive critical medications without delay, preventing health complications.
• Fulfills Regulatory and Contractual Requirements
  Many LTC contracts and regulations mandate 24/7/365 pharmacist availability, making compliance essential for maintaining contracts.

• Routine and Emergency Deliveries
  
  • Routine deliveries should occur at least once per month, with additional deliveries as needed for medication changes or urgent needs.
  • Patients recently discharged from a hospital or facility may require more frequent deliveries (e.g., every 7 or 14 days).
• Delivery Documentation
  
  • All deliveries must include proof of delivery, such as:
    
    • A photo of the package delivered to the home.
    • A signed receipt or manifest from the caregiver, family member, or patient.
    • Documentation can be captured electronically or on paper.
  • Patients or caregivers must be educated during onboarding about delivery processes and what actions to take if no one is available to receive the delivery.
• Delivery Execution
  
  • Deliveries can be handled by:
    
    • The pharmacy directly.
    • A courier service.
  • Pharmacies must ensure timely and secure delivery of medications.

• Ensures Timely Access to Medications
  Routine and emergency delivery services help ensure that patients receive their medications at the right time and dose, reducing the risk of treatment interruptions.
• Supports High-Risk Patients
  Frequent deliveries for patients with complex or changing medication regimens, such as those recently discharged, promote adherence and safety.
• Enhances Patient and Caregiver Confidence Reliable delivery services reassure patients and caregivers that their needs will be met promptly and consistently.

• Develop and Standardize Forms and Reports
  
  • Create templates for commonly required forms, including medication instructions, health monitoring tools, and ordering guides.
  • Regularly update templates to align with regulatory and operational requirements.
• Educate Patients and Caregivers
  
  • Train patients, families, and caregivers on how to use provided forms and tools effectively.
  • Offer written or digital instructions and follow up to ensure understanding.
• Collaborate with Families
  
  • Work closely with families to understand their needs and customize forms and reports accordingly.
• Ensure Compliance with Controlled Substance Regulations
  
  • Provide secure, easy-to-use forms for controlled substance tracking.
  • Educate caregivers and patients on legal and safety requirements for managing these medications.

• Supports Medication Adherence
  Clear and accessible materials help patients and caregivers follow complex medication regimens, reducing errors and improving health outcomes.
• Improves Patient Safety
  Providing specific instructions for medication administration ensures medications are used correctly and safely.
• Enhances Monitoring and Management
  Tools for tracking health metrics enable better management of chronic conditions, providing critical data for healthcare providers.

• Emergency Boxes
  
  • Not Required for Long-Term Care Pharmacy at Home
    
    • Emergency medication kits (e-kits) are generally not necessary for LTC Pharmacy at Home services unless mandated by state law.
    • Pharmacies should confirm state-specific requirements to ensure compliance.
  • Special Considerations
    
    • If the pharmacy is viewed as an LTC provider under state regulations, it may need to supply e-kits.
    • Pharmacies must ensure they are prepared to meet these requirements if applicable, including establishing protocols for emergency supply management and compliance.
• Emergency Log Books
  
  • Not Required for LTC Pharmacy at Home
    
    • Since emergency boxes are not typically required for LTC Pharmacy at Home, log books for tracking and charging medications from emergency stock are also unnecessary.
  • State-Specific Requirements
    
    • If state laws necessitate the provision of e-kits, pharmacies must establish a system for logging medication usage, charges, and maintaining comprehensive records of resident medication orders and administration.

• Assess State Law Requirements
  
  • Research and document state-specific mandates regarding e-kits and emergency supply management.
• Prepare for E-Kit Management
  
  • If e-kits are required, implement both facility-based and at-home procedures for:
    
    • Maintaining and replenishing emergency stock.
    • Logging and charging for medications used from emergency supplies.
    • Recording medication orders and administration in compliance with state and federal laws.

• Aligns with NCPDP Guidelines
  Following the NCPDP definition for Level of Service ensures LTC Pharmacy at Home services meet industry standards.
• Ensures Compliance
  Understanding and adhering to state-specific requirements protects the pharmacy from potential regulatory issues.
• Supports Quality Care
  If emergency supplies are required, having a clear and compliant system in place ensures patients receive timely access to critical medications.

• Initial Assessment by a Qualified Healthcare Provider
  
  • A licensed healthcare provider (e.g., physician, nurse practitioner, or other qualified clinician) must conduct an initial assessment of the patient.
  • This assessment should evaluate the patient’s skilled care needs, chronic or complex conditions, medication management requirements, and overall suitability for Long-Term Care at Home (LTCH) services.
• Pharmacist Review and Attestation
  
  • The pharmacist at the dispensing pharmacy must review the healthcare provider’s assessment to ensure it meets LTCH service standards.
  • The pharmacist must attest to the accuracy of the assessment before submitting any claims under the LTC NPI for the patient.
• Standardized Patient Qualification Form
  
  • The assessment must be documented using the Standard Patient Qualification Form, ensuring consistency and compliance across patients.
  • This form must be completed at the time of qualification and redone every six months to confirm the patient’s ongoing eligibility.
  • The form must be securely stored in the patient’s profile, either electronically or in paper format.
• Document Storage and Accessibility
  
  • The patient qualification form must be readily accessible for audit or review by payers or regulatory entities.
  • Use the Standard Patient Qualification Form, located HERE, to document assessments.

• Ensures Appropriate Use of Long-Term Care Pharmacy at Home Services
  Conducting thorough qualifications prevents misuse of LTCH services, ensuring that only eligible patients receive specialized care.
• Supports Accurate Claims Submission
  Reviewing and attesting to patient eligibility ensures claims are submitted correctly under the LTC NPI, reducing the risk of payment rejections or audits.
• Maintains Regulatory Compliance
  Adhering to patient qualification standards aligns with payer and regulatory expectations.
• Promotes Continuity of Care
  Regular reassessments ensure that patients continue to meet eligibility criteria and receive the level of care appropriate to their evolving needs.

• Definition and Scope of MDR
  
  • Combination of DUR and Medication Reconciliation: The MDR integrates the screening and evaluation of DUR with the verification and clarification of medication reconciliation.
  • Qualified Pharmacist: A licensed and qualified pharmacist must complete the MDR to ensure clinical expertise is applied.
• Frequency of MDR
  
  • Monthly Review: An MDR must be conducted for every patient at least once a month to evaluate the ongoing appropriateness of the medication regimen.
  • Upon Dispensing: An MDR may be completed each time the pharmacy dispenses medication to the patient, including new prescriptions, refills, or changes in therapy.
• Documentation in the Patient Profile
  
  • The MDR findings and actions taken must be thoroughly documented in the patient’s profile.
  • Documentation should include:
    
    • Changes in medication therapy.
    • Identified drug interactions, duplications, or contraindications.
    • Communication with healthcare providers or caregivers regarding medication adjustments.
• Collaboration with Healthcare Providers
  
  • Any concerns or recommendations identified during the MDR must be promptly communicated to the patient’s healthcare team.
  • Adjustments to the medication regimen must be made in collaboration with providers and documented accordingly.

In traditional long-term care (LTC) settings, medication management is often reviewed by multiple layers of healthcare professionals, including consulting pharmacists, floor nurses, and medical directors, ensuring comprehensive oversight. In the Long Term Care Pharmacy at Home model, while patients are managed by a pharmacist at the dispensing pharmacy, they do not have access to these additional layers of review. To compensate for this difference, the Medication Dispensing Review (MDR) process ensures that home-based patients receive the same meticulous attention to their medication regimens, promoting safety, accuracy, and efficacy in the home setting.

• Enhances Patient Safety
  
  • Combines two critical safety processes—DUR and medication reconciliation—to identify and address potential medication risks.
• Improves Medication Management
  
  • Regular MDRs ensure that medication regimens remain appropriate and effective as patient conditions and care plans evolve.
• Reduces Errors and Adverse Events
  
  • Identifying and resolving issues such as duplications, contraindications, or incorrect dosages minimizes the risk of adverse drug events.
• Supports Coordination of Care
  
  • Clear documentation and communication with healthcare providers ensure that all members of the care team are aligned, improving the patient’s overall treatment outcomes.
• Fulfills Compliance and Quality Standards
  
  • Conducting and documenting MDRs aligns with regulatory requirements and payer expectations, ensuring compliance and supporting the pharmacy’s credibility.