Quality Use of Medicines (QUM)

Quality Use of Medicines (QUM) is a service provided to an Australian Government funded residential aged care facility (ACF) through a facility-wide approach. All parties involved need to understand how such activities relate to the needs of the facility and its residents. A registered pharmacist conducts a QUM in association with appropriate members of the ACF.

About QUMs

Under the Fifth Community Pharmacy Agreement (5CPA), the new QUM services focus on improving practices and procedures relating to medicine use in Australian Government funded ACF.  QUM services cover areas such as medication advisory activities, education and continuous improvement. They are designed to help ACFs in meeting the healthcare needs of residents. The type and frequency of QUM services are to be documented in the Service Agreement between the QUM service provider and the ACF. 

QUM services may be conducted by a registered or accredited pharmacist. Since 1 October 2011, QUM has been separate from Residential Medication Management Review (RMMR) services and service providers must register and claim separately to provide QUM services.

Service provider eligibility criteria

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

• a registered 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 registered pharmacists to conduct QUM services on their behalf.

The applicant must also:

• hold a current, valid QUM Service Agreement with the ACF for QUM services to be provided
• provide all information needed by Medicare Australia for assessment of the application, to determine eligibility to participate in the QUM program
• agree to accept the service fee as full payment for the QUM services as specified in the QUM terms and conditions at no cost to the ACF.

How to become a QUM service provider

All applicants who want to be a QUM service provider must agree to the terms and conditions [PDF, 162Kb], meet the eligibility criteria and complete the MMR programs service provider application form [PDF, 290Kb].

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

Who conducts a QUM service?

QUM services are conducted by a registered pharmacist associated with a QUM service provider that has a current Service Agreement with an ACF.

Aged care facility eligibility criteria

All Australian Government funded residential aged care facilities (ACF) are eligible for QUM services by entering into a QUM Service Agreement with an approved QUM service provider. Where a ACF has beds for both aged care and for transition care, only the aged care beds are eligible for QUM services.

QUM Service Agreements

To become an approved QUM service provider, a valid QUM Service Agreement must be in place. A QUM Service Agreement is an agreement between a prospective QUM service provider and an ACF, for the provision of QUM services. All Australian Government funded ACFs are eligible to access QUM services.

All RMMR Service Agreements that included associated QUM services were terminated by Medicare Australia on 30 September 2011. A QUM Service Agreement must be entered into with the ACF for the provision of QUM Services only.

The approved QUM service provider is responsible for making sure the Service Agreement entered into with the ACF is a valid QUM Service Agreement. The approved QUM service provider makes sure QUM services are conducted by a pharmacist who is able to respond appropriately to requests from the ACF and services adhere to recognised professional standards.

The QUM Service Agreement must include a work plan that details the agreed QUM activities between the ACF and the approved QUM service provider. The activities must be from the approved list of QUM activies.

Agreed QUM activities

Only one QUM service provider may be registered for each ACF.

The agreement may be terminated by the ACF or the approved QUM service provider with 30 days written notice.

The QUM Service Agreement provided is a 'model agreement' and can be altered with agreement by both parties.  Changes must be consistent with the QUM program terms and conditions.

• Model QUM Service Agreement [PDF, 32Kb]
• Model QUM Service Agreement [RTF, 324Kb]

Signing Service Agreements

A QUM service agreement should be signed by a person who is authorised to sign the agreement on behalf of the Aged Care Facility and, if the service provider is not an individual (e.g. if the service provider is a company), a person who is authorised to sign the agreement on behalf of the service provider.  If the service provider is an individual, the QUM service agreement should be signed by that individual.  The signatures of the authorised signatories should also be witnessed, with the witness signing in the space provided.

The model QUM service agreement includes a signature block for use if the service provider is an individual and a signature block for use if the service provider is not an individual.  You should delete whichever of those signature blocks is not applicable before signing the agreement.

Further information on Service Agreements is available at Department of Health and Ageing.

or call 1800 020 103

Application form

To apply to become a QUM service provider, you must complete a Medication Management Review (MMR) Program application form [PDF, 290Kb].

Note: To help reduce the amount of paperwork, a combined application form has been developed and can be used to apply for the Home Medication Review (HMR) program, the Residential Medication Management Review program and the Quality Use of Medicines (QUM) services.

The form must be signed by:

• the independent registered pharmacist who is applying solely on his/her own behalf to become an approved QUM service provider
• all owners of an approved section 90 pharmacy (National Health Act 1953), where the application seeks approval of that pharmacy as an approved QUM service provider, or
• the registered pharmacist or authorised signatory, as proprietor of any other business entity, where the application seeks approval of that business entity as an approved QUM service provider.

Applicants must provide a copy of their current QUM Service Agreement, with the aged care facility (ACF) along with certificates of accreditation with the application.

• Medication Management Review Program application form [PDF, 290Kb]
• MMR Program Terms and Conditions [PDF, 162Kb]

Send your completed application form, including your Service Agreement to:

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

Fax: 08 8274 9373

Payment information

Payments for QUM services will be made in arrears by Medicare Australia once a completed payment application form is received from the QUM service provider. 

Payments will only be made for QUM services provided to ACFs by approved QUM service providers. 

The QUM Service fee will consist of a base annual amount of $240 plus $24 per eligible aged care place within the residential aged care facility. The fee is paid quarterly which equates to a quarterly payment of $60 for the base amount and $6 per quarter per eligible aged care place.

QUM payments are based on the number of eligible aged care places provided on your MMR application form.  If there is a change to the number of eligible aged care places in the ACF, service providers need to complete a QUM change of places form. If you do not complete a QUM change of places form, the payment will be based on the lower of the eligible aged care place numbers provided either at the time of application or in the payment application form. 

No adjustments to payments will be made where the number of eligible aged care places changes during the quarter.  The change to the number of eligible aged care places will take effect from the beginning of the following quarter.

A minimum of one QUM service must be provided each quarter to receive the QUM payment.

A QUM claiming quarter must:

• cover three consecutive months
• fall within the start and end dates of the approved service agreement(s), and
• not overlap any previously claimed quarters.

Quality Use of Medicine (QUM) payment application form

Please note: the section on the QUM payment application form asking whether the registered pharmacist conducting the QUM services is accredited or not will be mandatory as of 1 July 2012.

To claim for QUM services use the Quality Use of Medicines payment application form [PDF, 130Kb].

Before claiming for a QUM service you must apply to Medicare Australia for approval as a QUM service provider. The approved QUM service provider will be paid once a valid QUM payment application form has been received and approved by Medicare Australia.

The QUM payment application form must be completed by the pharmacist and signed by the:

• director of nursing (DON) or their authorised representative
• approved service provider.

This certifies that the details on the claim form are true and correct and that all QUM services claimed were conducted in accordance with the QUM terms and conditions.

QUM service providers must make sure the payment application is consistent with the QUM services and frequency of activities agreed with the ACF and as documented in the Service Agreement.

Claims for payment must be fully completed and submitted to Medicare Australia on the QUM payment application form.  Each payment application must include:

• name of QUM service provider
• whether the registered pharmacist conducting the QUM services is accredited or not (mandatory as of 1 July 2012)
• name and identification number of the ACF where the QUM services have been conducted
• number of eligible aged care places in the ACF where the QUM services have been conducted
• name, signature and registration number of the registered pharmacist who has performed the QUM services
• period in which the QUM services have been conducted
• identification of at least one QUM activity performed in the quarter
• signature of the approved QUM service provider certifying that the details on the claim form are true and correct and that all QUM services claimed were conducted in accordance with the guidelines and standards for the QUM program
• signature of the DON or authorised representative and declaration from the DON that services were provided.

Payment will not be made where:

• information about whether the pharmacist is accredited or not is not included (mandatory as of 1 July 2012)
• QUM services are provided before a QUM Service Agreement is in place and approval as an approved QUM service provider has been confirmed by Medicare Australia
• QUM services are provided after the QUM Service Agreement expires or is terminated
• QUM services are provided after QUM service provider status is revoked
• QUM services claimed do not comply with the terms and conditions.
  

Any overpayments will be recovered by Medicare Australia through debt recovery action. 

Send your completed QUM Payment application form to:

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

Fax: 08 8274 9373

Change of details

To change your MMR program details, use the MMR Change of details form [PDF, 412Kb].

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, section 90 pharmacy or ACF changes, a new MMR application form and Service Agreement [PDF, 31Kb] must be submitted to Medicare Australia. 

To change the number of eligible places at an ACF use the QUM Change of places form.

The new number of eligible places will take effect in the next claiming quarter after a correctly completed QUM Change of Places [PDF, 85Kb] form is received.

Frequently asked questions

What are the eligibility criteria to become a QUM service provider?

To be eligible to become an approved QUM service provider, you must:

• be a registered pharmacist
• be the owner of a Section 90 Pharmacy, or
• be the proprietor of a business entity that employs or has a service contract with one or more registered pharmacists to conduct QUM Services on their behalf

You must also:

• hold a current valid QUM Service Agreement with an Australian Government funded ACF for QUM Services to be provided
• provide all the information needed by Medicare Australia for assessment of the application, to determine eligibility to participate in the QUM Program
• agree to accept the service fee as full payment for the QUM services as specified in the QUM Service Agreement at no cost to the eligible aged care resident or the ACF.

Note: QUM services may be provided by a different pharmacist or business than the pharmacist or business that provides the RMMR services and may be provided by either a registered or accredited pharmacist.

How do I apply to become a QUM service provider?

To apply to become a QUM service provider you need to complete a Medication Management Review application form and submit it and a copy of the QUM Service Agreement [PDF, 31Kb] to Medicare Australia.

Note: you will not be able to provide QUM services until you have been advised of the receipt and approval of your application.

Who may conduct a QUM service?

A QUM service may be conducted by either a registered or accredited pharmacist.

The QUM application for payment form asks whether the pharmacist is accredited. From 1 July 2012, this information will be mandatory. Any claims received on or after 1 July 2012 that do not include this information will be rejected.

This information is for internal research about the QUM program and is not a requirement of QUM registration.

What does a Quality Use of Medicines service consist of?

QUM services cover areas such as medication advisory activities, education and continuous improvement. They are designed to assist ACFs in meeting the healthcare needs of residents. The type and frequency of QUM services are to be documented within the Service Agreement between the QUM service provider and the ACF. 

What is the QUM service fee?

The QUM service fee will consist of a base annual amount of $240 ($60 per quarter) plus $24 ($6 per quarter) per eligible aged care place within the ACF. The fee is paid by Medicare Australia on a quarterly basis on the receipt of a correctly completed QUM Payment application form.

There are no set quarters for QUM services.  Claims for payment for providing QUM services can commence at the beginning of any month, for three consecutive months, i.e. one quarter.

What if the number of eligible aged care places changes during a quarter?

Service providers will need to complete a QUM change of places form. The change to the number of eligible aged care places will take effect from the beginning of the following quarter.  No adjustments to payments will be made where the number of eligible aged care places changes during a quarter.

Does the QUM service provider have to be the same person as the RMMR service provider?

No, as the RMMR and QUM services are being separated, ACFs may engage separate service providers.

More information

Changes to the RMMR and QUM programs under the Fifth Community Pharmacy Agreement (5CPA)

A fact sheet on the changes to the RMMR program and QUM services is available from the Department of Health and Ageing

More information

For more information, or application and claim forms, please call 08 8274 9641

Email: sa.guild.govt.programs@humanservices.gov.au

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

For more information, or application and claim forms, please call 08 8274 9641

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Last updated: 15 May, 2013

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