Long Term Care (LTC)

Revised: May 5, 2010

Long Term Care (LTC) Facilities

Supply Requirements

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.

"Catch-up" Supplies of Medication

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.

Emergency Kit Medication Replacement

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:

· If the dose is the only one that is given, the pharmacy replacing the dose may bill MHCP for the dose

· If the dose is the first of a series of doses, it must be billed to MHCP together with subsequent doses. For example, if the order is for Rocephin 1gm IM once and the dose is taken from the emergency kit, the pharmacy may replace that dose and bill DHS. If the order is for Rocephin 1gm IM once daily for 7 days and the first dose is taken from the emergency kit, the pharmacy should not bill DHS for 1 dose to replace what was taken from the kit and 6 doses for the remainder of the supply. All 7 doses must be billed as one prescription.

Lost Drugs

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.

Over the Counter Drugs

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.

Pass Meds, School or Job Med Supplies

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.

Solutions, Irrigations and Supplies for LTC Facilities

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:

· Compounded antibiotic irrigation solutions

· Normal saline for irrigation

· Saline for inhalation or trach care

· Sterile water for irrigation

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.