Long Term Care pharmacies and facilities are subject to the same days supply limitations as all other MHCP enrolled pharmacies. Minnesota Rule requires initial or refill supply of maintenance drugs to be dispensed in not less than a 30 day supply unless the pharmacy is using unit dose dispensing.
When unit dose dispensing is used, the pharmacy may not bill MHCP more frequently than once per calendar month or when a minimum of 30 dosage units have been dispensed, whichever option results in less frequent billing.
Current Minnesota Statutes and Rules prohibit billing for "catch-up" supplies. Some pharmacies that serve nursing facilities dispense small "catch-up" supplies of medications if the facility runs out before the end of a billing cycle.
Example: the pharmacy dispensed a 30-day supply only to have the facility call 25 days later indicating that it is out of the drug. The pharmacy then dispenses a 5-day supply and bills DHS. Several days later, the pharmacy bills DHS for another 30-day supply in order to get back on schedule.
If a long-term care facility uses a dose of medication from an emergency kit, bill that dose separately to MHCP only if certain conditions are met:
Do not bill DHS for medication sent to a long-term care facility or group home if lost or damaged. If the pharmacy lost the medication before delivering it to the facility, the pharmacy must send a replacement supply to the facility without billing DHS or the recipient. If the facility lost the medication after it was delivered, the pharmacy must send a replacement supply that is then billed to the facility, not to DHS or the recipient.
During the course of a Medicare or Medicaid stay, Federal law requires LTC facilities to provide residents with medically necessary over the counter (OTC) drugs used on an occasional or as needed basis. These drugs are part of the LTC facility’s per diem and are reported in a cost report to MHCP.
Over the counter drugs prescribed for a specific resident for scheduled use should be dispensed in the manufacturer’s unopened package and submitted separately to MHCP for reimbursement.
If an MA recipient, living in a nursing facility or group home, needs a small quantity of medication for passes, school, a job, or day programs, do not separately bill DHS.
Example: if a recipient receives carbamazepine 200mg TID, do not separately bill for 70 tablets for use in a group home and 20 tablets for use at school. Bill the total 90 tablets at one time to DHS. The pharmacist can package the medication in any manner consistent with state and federal pharmacy laws and regulations. In this example, that might mean packaging 70 tablets in a unit dose container and 20 in a vial. However, packaging the prescription in two containers does not entitle the pharmacy to two dispensing fees.
MHCP does not pay for solutions, irrigations or supplies used in LTC facilities for respiratory or wound care. This includes, but is not limited to:
These are all part of the per diem paid to the long-term care facility. Pharmacies should not bill these products as drugs when the recipient is in the facility.Report/Rate this page