Home Medicines Review (HMR)

A Home Medicines Review (HMR) involves the patient, their general practitioner (GP), an accredited pharmacist and regular community pharmacy. In some cases other relevant members of the healthcare team, such as nurses in community practice or carers, are included. The pharmacist visits the patient at their home, reviews their medicine routine and provides their GP with a report. The GP and patient then agree on a medicine management plan.

The objectives of an HMR are to:

• achieve safe, effective and appropriate use of medicines by detecting and addressing medicine-related problems that interfere with the patient’s desired outcomes
• improve the patient's quality of life and health by using a best practice approach, that involves cooperation between the GP, pharmacist, other relevant health professionals and the patient (and where appropriate, their carer)
• improve the patient's and health professional’s knowledge and understanding about the patient’s medicines
• build cooperative working relationships between members of the healthcare team in the interests of patient health and wellbeing.

Changes to the HMR program from 1 October 2011

All HMR claims, regardless of when that service was conducted, must be submitted on the new HMR Claim cover sheet and Claim confirmation for HMR service form [PDF, 243Kb], available below in Forms. If a patient has signed the old HMR claim form, you may attach it when you submit the new form with all fields completed.

 From 1 October 2011, GPs can provide an HMR referral directly to an accredited pharmacist, as well as to a patient’s usual community pharmacy. The community pharmacy and/or accredited pharmacist must have approval from Medicare to conduct HMR services.

From 30 September 2011, Medicare stopped payments for the HMR Rural Loading. On 1 October 2011, the payment was replaced by the HMR Rural Loading Allowance, administered by the Pharmacy Guild of Australia (the Guild). Any claims for travel should be sent to the Guild, regardless of whether the service was provided before or after 1 October 2011. For more information on how to claim for the HMR Rural Loading Allowance go to the 5CPA website.

HMR service providers registered before 1 October 2011 must provide Medicare with the details of all accredited pharmacists conducting HMR services on their behalf using the HMR S90 pharmacy notification of accredited pharmacists form that was mailed out in June. An interactive form can be found in the Forms section below.

Medicare needs all accredited pharmacist details to process claims received by Medicare after 15 September 2011.

Service Provider eligibility criteria

To be eligible for approval by Medicare Australia as an HMR service provider the applicant must be:

• an accredited pharmacist, or
• the owner of a Section 90 Pharmacy, or
• the proprietor of a business entity that employs or has a service contract with one or more accredited pharmacists to conduct HMR services on its behalf.

How to become an HMR service provider

All applicants who want to be an HMR service provider must agree to the terms and conditions, meet the eligibility criteria and complete the MMR programs service provider application form. 

All applicants must receive written approval to be an HMR service provider from Medicare before providing services.

Who conducts an HMR?

A GP can refer a patient to a community pharmacy that employs an accredited pharmacist to conduct the HMR service on their behalf, or directly to an accredited pharmacist to conduct  the HMR service.  The community pharmacy and/or accredited pharmacist must have approval from Medicare to conduct HMR services.

If there is no access to an accredited pharmacist in a timeframe suitable to the patient, a registered pharmacist may conduct the interview and give the information to an accredited pharmacist who completes the clinical assessment and writes the report.

Accreditation

An accredited pharmacist is a pharmacist who has undertaken specified education programs or examinations and has received accreditation to conduct medication reviews from the Australian Association of Consultant Pharmacy (AACP) or the Society of Hospital Pharmacists of Australia (SHPA).

Patient eligibility

A GP must determine that a review of a patient living at home is clinically necessary to ensure the quality use of medicines or to address a patient's needs.

Example of risk factors may include patients:

• currently taking five or more regular medicines
• taking more than 12 doses of medicine per day
• with significant changes to their medicine regiment in the last three months
• recent discharge from hospital
• taking medicine with a narrow therapeutic index or that requires therapeutic monitoring
• with symptoms suggestive of an adverse medicine reaction
• having difficulty managing their own medicines because of literacy or language difficulties, or impaired sight
• attending a number of different doctors, both general practitioners and specialists.

The HMR service is not available to in-patients of a hospital, day hospital facility or care recipients in residential aged care facilities. For individuals living in Australian Government funded residential aged care facilities, see the Residential Medication Management Review (RMMR) web page.

Confidentiality

All information relating to the HMR is confidential. Information from the patient’s record can only be given to the pharmacist conducting the review, with the patient’s consent. Input from each person involved in the review process is documented in the review report, as well as the recommendations and management plan.

The GP and HMR service provider will keep a full record of all documents for auditing purposes. Pharmacists should keep all records necessary to show that they have complied with HMR terms and conditions, for seven years.

Receiving payments

Medicare must approve your application to provide HMR services before you can provide HMR services or receive payment.

Medicare will pay $197.76 (indexed annually on 1 July) to the approved service provider for each HMR undertaken after a referral by a GP.

Claims are to be submitted by completing the HMR claim cover sheet and Claim and confirmation for HMR services form, available below in Forms.

Forms

S90 notification of accredited pharmacists form

If you were registered as an HMR service provider before 1 October 2011, you can use the Home Medicines Review Section 90 pharmacy notification of accredited pharmacists form to submit the details of the accredited pharmacists who will conduct HMR services on your behalf from 1 October 2011.

MMR programs service provider application form

To apply to be an HMR service provider complete and return the MMR programs service provider application form.

We have developed user guides to help you complete the MMR programs service provider application form.

• Section 90 Pharmacy application form user guide [PDF, 123Kb]
• Non-section 90 Pharmacy application form user guide [PDF, 124Kb]

5CPA HMR claim forms

The new HMR claiming system requires several extra mandatory fields under the 5CPA arrangements.

The new HMR Claim cover sheet and Claim and confirmation for HMR service form [PDF, 243Kb] with these fields is now available and should be used for all HMR claims, including claims for HMR services conducted before 1 October 2011. If a patient has signed the old HMR claim form, you may attach it when you submit the new form with all fields completed.

Rural Loading Allowance

On 1 October 2011, The Guild began administering all Rural Loading payments, now known as HMR Rural Loading Allowance. All claims for Rural Loading Allowance payments must be made directly to The Guild. This includes Rural Loading Allowance claims for services that were conducted before 1 October 2011.

Change of details

To change your MMR program details, use the MMR Change of details form. [PDF, 150Kb]

This form allows you to:

• (HMR and RMMR only) notify Medicare of new accreditation dates for existing accredited pharmacists - attach new accreditation certificate/s with form
• Add new pharmacists - attach new accreditation certificate/s with form, if necessary
• Cease existing pharmacists
• (RMMR and QUM only) Notify DHS of a change of ACF name
• (Non-Section 90 pharmacies only) change name, address and bank details

Note: Section 90 pharmacies cannot change their bank account details on this form. Refer to the Notification of bank account details for community pharmacy [PDF, 199Kb] form to change this information.

If a Section 90 pharmacy changes approval number, a new MMR application form must be submitted to Medicare Australia.

If ownership of the business entity or section 90 pharmacy changes, a new MMR application form and Service Agreement [PDF, 29Kb] must be submitted to Medicare Australia. 

New forms are available from the Community Pharmacy Agreement Team, on (08) 8274 9641 or by email: sa.guild.govt.prog@medicareaustralia.gov.au

Terms and Conditions

By signing the MMR programs service provider application form, you are agreeing to the MMR terms and conditions.

Terms and Conditions for Medication Management Review (MMR) programs. [PDF, 148Kb]

New forms are available from the Community Pharmacy Agreement Team, on (08) 8274 9641 or by email: sa.guild.govt.prog@medicareaustralia.gov.au

The review process

An HMR involves the following steps:

1. Identification of person requiring HMR service;
2. Assessment by GP of clinical need for an HMR from a quality use of medicines perspective with the patient as the focus;
3. Formal initiation of HMR;
4. Patient is informed and gives their consent;
5. Referral by GP to the patient’s preferred community pharmacy or accredited pharmacist who must have prior approval from Medicare to conduct HMR services;
6. Approved HMR service provider coordinates the HMR service and notifies the GP of the details of the accredited pharmacist who will conduct the service;
7. The preferred address and time for HMR are arranged with the patient;
8. Pharmacist conducts HMR;
9. Review of information by accredited pharmacist and development of suggested management strategies;
10. Preparation of report by accredited pharmacist;
11. Report provided to and discussed with GP;
12. Medication management plan agreed between patient and GP;
13. Implementation of agreed actions with appropriate follow-up and monitoring.

Frequency of HMR

One HMR service can be conducted per eligible person in a 12 month period, unless there has been a significant change in the person’s condition or medication regimen, in which case an additional HMR service can be provided.

Reasons why an additional HMR may be requested include:

• discharge from hospital in the previous four weeks
• significant change to medical regimen in the past three months
• change in medical condition or abilities (including falls, cognition, physical function)
• prescription of a medication with a low therapeutic index or requiring therapeutic monitoring
• presentation of symptoms suggestive of an adverse drug reaction
• sub-therapeutic non-compliance or problems with managing medication-related devices, or
• risk of inability to continue managing own medications due to changes in dexterity, confusion or impaired vision.

Additional HMRs undertaken should be documented in the patient’s history by the GP and where relevant in the dispensing record by the community pharmacy.

Frequently Asked Questions

How often can claims be submitted?

Claims can be submitted at any time.

What is a ‘claim reference’?

The claim reference is a number you generate for record keeping/referencing purposes. A suggested claim reference number would be the last two digits of the year followed by what number the claim is for that year. For example, if the claim is the first claim submitted by the HMR service provider for 2012, the claim reference number would be 1201. Pharmacy approval numbers are not to be used as part of the reference number.

What does ‘Service number_of_in this submission’ mean?

Each review requires a service number and must be recorded on the Claim and confirmation form as well as the number of services submitted for payment. For example, if there are 10 services claimed the service number would be 1 of 10.

Who can sign the cover sheet?

The cover sheet can be signed and dated by an approved or authorised person.

An approved person is the aproved HMR service provider, for example, the owner of the pharmacy or independent accredited pharmacist or owner of the business.

An authorised person is another person authorised by the owner to sign claim forms on their behalf and registered as an authorised person with Medicare.

Can I fax my completed cover sheet and claim and confirmation forms?

Yes, you can send your cover sheets and claim forms via fax to 08 8274 9373*.

When is the cut-off to submit HMR claims?

HMR claims can be submitted at any time, however, payments are only made once a month. Payment will be made by Medicare within 30 days of receipt of correctly submitted claims that are received within 14 days from the start of a month. For claims received after 14 days from the start of a month, payments will be made in the following monthly payment run.

Where do I submit my claim forms?

Claims are to be submitted to:

Community Pharmacy Agreement Officer
Pharmaceutical Benefits Branch
Medicare 
GPO Box 9826
Adelaide SA 5001

Fax: 08 8274 9373*

Claims must not be sent to state offices with prescription claims as this could delay payment.

A doctor has asked me to perform an HMR in an aged care facility. Is the HMR service available to residents in aged care facilities?

No, the HMR service is not available for in-patients of a hospital, day hospital facility or for care recipients in government funded residential aged care facilities. For Medication Management Reviews for patients of an Australian Government funded aged care facility, go to Residential Medication Management Reviews (RMMR).

Can I perform an HMR by telephone?

No, there is no provision for telephone interviews.

How much do approved HMR service providers get paid?

Approved HMR service providers receive $197.76 per HMR. This amount is indexed annually.

How do I get paid?

Payments are made into the bank account where pharmacy prescription claims are paid or to the account nominated by the independent accredited pharmacist or business for HMR payments.

How do I complete the MMR programs service provider application form?

We have developed user guides to help you complete the MMR programs service provider application form.

• Section 90 Pharmacy application form user guide [PDF, 123Kb]
• Non-section 90 Pharmacy application form user guide [PDF, 124Kb]

Why have the HMR claim forms changed?

The HMR claim cover sheet and Claim and confirmation for HMR services form have been updated to reflect new mandatory information required under the 5CPA. The new fields must be completed in order for claims to be paid.

Can I submit a claim for a service conducted before 1 October 2011?

Yes, however, all claims must include the new claiming information. If the patient has signed an old Claim and confirmation for HMR services form, you must complete and attach the new HMR claim cover sheet and Claim and confirmation for HMR services form [PDF, 243Kb] to the old form when submitting it. The patient is not required to sign the new forms if they have previously signed an old one.

More information

Changes to the HMR program under the Fifth Community Pharmacy Agreement (5CPA)

For the fact sheet on the changes to the HMR program under the 5CPA, including frequently asked questions go to: http://www.health.gov.au/internet/main/publishing.nsf/Content/ppsac-hmr

For more information on HMR

Email: sa.guild.govt.prog@medicareaustralia.gov.au

Call: (08) 8274 9641* between 8:30 am and 5:00 pm Monday to Friday Australian Central Standard Time

Write: 

Community Pharmacy Agreement Officer
Pharmaceutical Benefits Branch
Department of Human Services
GPO Box 9826
Adelaide SA 5001

* Call charges apply.

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Last updated: 20 January, 2012

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