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 accredited 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 medication management plan.

The HMR program aims to increase quality use of medicines and reduce adverse medicine events. As part of this program, an accredited pharmacist must conduct a comprehensive review of a patient’s medicine in the patient’s home.

The objective of a HMR is to:

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

Changes to the HMR program from 15 March 2013

Changes to the HMR model from 1 October 2011 included a direct referral pathway. This allows the GP to refer to the patient’s preferred community pharmacy or an accredited pharmacist, and allows the patient to choose the most appropriate pharmacist to conduct the HMR review.

To clarify and strengthen the existing program specific guidelines and the Medication Management Review (MMR) Program Terms and Conditions, the following changes have been introduced effective 15 March 2013:

• a HMR must be conducted in a patient’s home
• when a HMR service can’t be conducted in a patient’s home, the accredited pharmacist must get prior approval from the Department of Health and Ageing (DoHA) before the review takes place. They must also attach evidence of approval to the claim form. Complete the Prior Approval Request form – Interview Conducted Outside the Patient's Home to get approval

Note: this approval can only be used for one HMR. If a further HMR is required, the pharmacist will need to seek prior approval from DoHA again

• a HMR must be conducted by an accredited pharmacist
• when an accredited pharmacist can’t conduct a HMR, they must get prior approval from DoHA before a registered pharmacist conducts the review with the patient. They must also attach evidence of approval to the claim form. Complete the Prior Approval Request form – Interview Conducted by a Registered Pharmacist to get approval

Note: this approval can only be used for one HMR. If a further HMR is required, they will need to seek prior approval from DoHA again

• the pharmacist who conducted the HMR must give a copy of the HMR report to the patient’s usual community pharmacy
• HMR services aren’t available to:
  • public or private hospital in-patients
  • day hospital in-patients, or
  • residents of an Australian Government funded residential aged care facility
• repeat HMRs should only be conducted if there is a significant change to a patient’s condition or medicine regimen
• HMR services conducted in one calendar month must be claimed on or before the last day of the next calendar month. Claims submitted outside this timeframe will not be paid
• measures will be taken to ensure patient consent is received before a HMR takes place
• improved audit and compliance arrangements.

These changes are outlined in more detail in the new MMR Terms and Conditions.

For more information about these changes, go to the 5CPA website.

For HMRs conducted on or after 15 March, you must submit your claims on the new claim forms:

• HMR claim and cover sheet (4123) [PDF, 134Kb]
• Claim and Confirmation for HMR service (4915) [PDF, 211Kb]

If you submit your claim on an old claim form, for a HMR conducted on or after 15 March 2013, it will not be paid.

Service provider eligibility criteria

To be eligible for approval by Medicare as a 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 a 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 on their behalf, or directly to an accredited pharmacist to conduct the HMR. The community pharmacy and/or accredited pharmacist must have written 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 can conduct the HMR if prior approval has been granted by DoHA. To get approval, complete the Prior Approval Request form – Interview Conducted by Registered Pharmacist.

If a registered pharmacist, who has approval from DoHA, conducts the HMR, they must 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 if a patient is eligible for a HMR.

GPs must assess whether they need to review the patient’s medicines to make sure medicine is being used properly to achieve the best outcome for the patient.

Patients could be eligible for a HMR if they:

• take more than 12 doses of medicine per day
• have difficulty managing their own medicines because of literacy or language difficulties, or impaired sight
• attend a number of different doctors, both general practitioners and specialists
• have been discharged from hospital in the previous four weeks
• have had a significant change to their medicine regimen in the past three months
• have experienced a change in their medical condition or abilities. This could include falls, cognition, physical function
• use prescription medicine with a narrow therapeutic index or medicine that needs therapeutic monitoring
• have symptoms of an adverse drug reaction
• have a sub-therapeutic response to therapy
• have problems managing medication devices, such as dose administration aids, or
• are at risk of, or can’t manage their own medicine due to, changes in dexterity, confusion or impaired vision.

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) webpage.

A HMR must be conducted in the patient’s home. When this isn’t possible, accredited pharmacists must get approval from DoHA before the review takes place. To get approval, complete the Prior Approval Request form – Interview Conducted Outside the Patient’s Home.

Confidentiality

All information relating to a HMR is confidential. Information from the patient’s record can only be given to the accredited 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 $200.92 (current as at 1 July 2012; this amount is indexed annually on 1 July) to the approved service provider for each HMR conducted after a referral by a GP.

HMR services conducted in one calendar month must be claimed on or before the last day of the next calendar month. Claims submitted outside these timeframes will not be paid.

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

Forms

Forms for HMRs conducted on or after 15 March 2013

Submit your HMR claim by completing the HMR claim cover sheet (4123) [PDF, 134Kb] and the Claim and Confirmation for HMR service (4915) [PDF, 211Kb].

If the HMR must take place outside a patient’s home, you must get approval from DoHA before the review. To get approval, complete the Prior Approval Request form—Interview Conducted Outside the Patient’s Home.

If an accredited pharmacist can’t conduct the HMR, you must get approval for it to be conducted by a registered pharmacist. To get approval, complete the Prior Approval Request form – Interview Conducted by Registered Pharmacist.

Any claims submitted on an old claim form, for a HMR conducted on or after 15 March 2013, will not be paid.

S90 notification of accredited pharmacists form

If you were registered as a HMR service provider before 1 October 2011, you can use the Home Medicines Review Section 90 pharmacy notification of accredited pharmacists form [PDF, 173Kb] to submit the details of the accredited pharmacists who will conduct HMR services on your behalf from 1 October 2011.

MMR program service provider application form

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

HMR Rural Loading Allowance

The Pharmacy Guild processes all payments for the HMR Rural Loading Allowance. To claim your payment, go to The Pharmacy Guild website.

Change of details

To change your details for the MMR program, use the MMR Change of Details form.

This form allows you to:

• remove pharmacists from the program if they no longer conduct HMRs
• HMR and RMMR only—notify Medicare of new accreditation dates for existing accredited pharmacists. New accreditation certificates must be attached to the form, if necessary
• RMMR and QUM only—notify Medicare if the name of your aged care facility has changed
• non-Section 90 pharmacies only—change your 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.

Service Agreement [PDF, 29Kb] must be submitted to Medicare.

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.

The HMR process

A HMR involves the following steps:

1. Identification of a person who needs a HMR
2. A GP assesses if there is a clinical need for a HMR from a quality use of medicines perspective with the patient as the focus
3. Formal initiation of HMR
4. The patient is informed and gives their consent
5. The GP refers the patient for a HMR with their preferred community pharmacy, or accredited pharmacist, who must have approval from Medicare before they conduct a HMR
6. An approved HMR service provider coordinates the HMR and notifies the GP of the details of the accredited pharmacist who will conduct the service
7. The preferred address and time for the HMR is arranged with the patient
8. An accredited pharmacist conducts the HMR (or registered pharmacist if prior approval has been granted by DoHA)
9. The accredited pharmacist reviews the information from the HMR and develops a suggested management strategy
10. The accredited pharmacist prepares a report
11. The report is provided to, and discussed with, the GP
12. The patient and GP agree on the medication management plan
13. Agreed plan is implemented with appropriate follow-up and monitoring.

Frequency of HMRs

One HMR can be conducted per eligible patient when a GP has referred them. 

HMR plans don’t need reviewing. Provision of a subsequent HMR should not be triggered on a 12 month referral cycle. Subsequent reviews can only be conducted when there is a significant change to a patient’s condition, medicine regimen, or if they’ve been referred for another HMR by a GP.

A patient may be eligible and benefit from an alternate medication management service available through community pharmacies such as a MedsCheck, Diabetes MedsCheck or Clinical Intervention. For more information on these programs go to the 5CPA website.

Reasons why an additional HMR may be requested include, if the patient:

• takes more than 12 doses of medicine per day
• has difficulty managing their own medicines because of literacy or language difficulties, or impaired sight
• attends a number of different doctors, both general practitioners and specialists
• has been discharged from hospital in the previous four weeks
• have had a significant change to their medicine regimen in the past three months
• has experienced a change in their medical condition or abilities, this could include cognition or physical function, or if they’ve had a fall
• uses prescription medicine with a narrow therapeutic index or medicine that needs therapeutic monitoring
• has symptoms of an adverse drug reaction
• has a sub-therapeutic response to therapy
• has problems managing medication devices, such as dose administration aids, or
• is at risk of, or can’t manage their own medicine due to changes in dexterity, confusion or impaired vision.

Additional HMRs conducted 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?

HMRs conducted in one calendar month must be claimed on or before the last day of the next calendar month. Claims submitted outside these timeframes will not be paid.

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.

What does ‘Service number of in this submission’ mean?

Each review requires a service number and must be recorded on the Claim and Confirmation for Home Medicines Review Service formas 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 approved 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?

HMRs conducted in one calendar month must be claimed on or before the last day of the next calendar month. Claims submitted outside these timeframes will not be paid.

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?

As at 1 July 2012, approved HMR service providers receive $200.92 per HMR. This amount is indexed annually on 1 July.

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.

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.

More information

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

For the fact sheet on changes to the HMR program under the 5CPA, including frequently asked questions go to DoHA’s website.

For more information on HMR

Email: sa.guild.govt.programs@humanservices.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: 10 May, 2013

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