What's new?

August 2013

The Department of Human Services Compliance Program for 2013-15 has been released.

Home Medicines Review (HMR)

The Home Medicines Review is continued under the Fifth Community Pharmacy Agreement  in accordance with arrangements set out under the Fourth Community Pharmacy Agreement.

Changes will be made to the Home Medicines Review program as part of the Fifth Community Pharmacy Agreement.

The Home Medicines Review (HMR) is funded under the Fourth Community Pharmacy Agreement designed to assist individuals living at home to maximise the benefits of their medicine regimen and prevent medication related problems. It is not available for in-patients of a hospital, day hospital facility or care recipients in residential aged care facilities.

The review involves the consumer's general practitioner and preferred community pharmacy and in some cases other relevant members of the healthcare team such as nurses in community practice or carers are included. In cooperation with the individual's general practitioner, the pharmacist visits the individual at home, reviews their medicine regimen, and provides the general practitioner with a report. The general practitioner and consumer then agree on a medicine management plan.

The objectives of HMR are 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 general practitioner, 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 medicines
  • facilitate cooperative working relationships between members of the health care team in the interests of patient health and wellbeing.

Who conducts a HMR

The general practitioner will refer the individual to their preferred community pharmacy, to complete the pharmacy component of the HMR service. The community pharmacist’s responsibilities will vary depending on whether they are accredited to conduct medicine reviews.

If there is no access to an accredited pharmacist in a time frame suitable to the individual, the community pharmacist may conduct the interview and give the information to an accredited pharmacist who will complete the clinical assessment and write the report.

 Accreditation

An accredited pharmacist is:

  • an experienced pharmacist who has undertaken specified education programs or examinations, approved by the Australian Association of Consultant Pharmacy (AACP) or the Society of Hospital Pharmacist Australia (SHPA)
  • continuing specified professional education and re-accreditation.

 How a pharmacy becomes a HMR service provider

Owners of a community pharmacy approved to supply pharmaceutical benefits under section 90 of the National Health Act 1953 can become approved HMR service providers if they meet specific criteria including access to an accredited pharmacist, in the application form.

Patient eligibility

A general practitioner must assess 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. Examples of risk factors include patients:

  • currently taking five or more regular medicines
  • taking more than 12 doses of medicine per day
  • with significant changes to their medicine regimen in the last three months, including recent discharge from hospital
  • taking medicine with a narrow therapeutic index or required therapeutic monitoring
  • with symptoms suggestive of an adverse drug reaction
  • having difficulty managing their own medicines because of literacy or language difficulties, 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.

 Confidentiality

All information is confidential. The information from the individual'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 general practitioner will hold a copy and the consumer’s pharmacy will keep a full record for auditing purposes. Pharmacy should be informed of how many years this documentation is to be kept for example, seven years.

Receiving payments

To receive payment for HMR services Medicare must

  • approve the application for approval to provide HMR services

Medicare will pay $194.07 to the approved service provider for each HMR undertaken after a referral by a general practitioner. Medicare also provides a rebate for a general practitioner's involvement in an HMR.

Claims are to be submitted monthly by completing the claim and confirmation form.

The review process

A HMR goes through the following stages:

  • identification of potential service recipients.assessment by general practitioner of clinical need for service from a quality use of medicines perspective with the individual as the focus and formal initiation of HMR if appropriate
  • informed consent obtained by the general practitioner during consultation
  • referral by general practitioner to individual's preferred community pharmacy
  • community pharmacy coordinates service delivery on receipt of referral and notifies the general practitioner of details of the service provider
  • the preferred venue and time for medicine review are arranged with the individual
  • appropriately accredited pharmacist conducts HMR
  • review of information by appropriately accredited pharmacist and development of suggested management strategies
  • preparation of report by appropriately accredited pharmacist
  • report provided to and discussed with general practitioner and community pharmacist
  • medication management plan agreed between individual and general practitioner
  • implementation of agreed actions with appropriate follow up and monitoring.

FAQ

 How frequently can I submit a claim?

Claims can be submitted once a month.

 What do I put as a claim reference?

The claim reference is a number you generate for reference. A suggestion is the year followed by the number of the claim for the year. For example, if the claim is the first claim submitted by the pharmacy for the year 2005, the reference number could be 0501. It is requested that the pharmacy's approval number not be used as part of the reference number.

The claim reference cannot be more than eight characters.

 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 a proprietor of the pharmacy.
  • An authorised person—is another pharmacist authorised by the proprietor to sign claim forms on their behalf and must be registered on the PBS system.
 Can I fax my completed cover sheet and claim and confirmation forms?

Yes. Medicare will accept cover sheets and claim forms via fax.

 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. If a claim is submitted by the end of the month, payment will be received early in the following month.

 Where do I submit my claim forms to?

Claims are to be submitted to: 

Community Pharmacy Agreement Officer
GPO Box 9826
Adelaide SA 5001

Do not send claims in with prescription claims to state offices as this could delay payment.

 What paperwork do I send with my claim form?

A cover sheet and an amended claim and confirmation form for HMR was introduced in February 2005 to allow pharmacies situated in rural and remote areas, (i.e. PhARIA categories 2, 3, 4, 5 or 6 [refer to GISCA websiteExternal link]), to claim a reimbursement of their travel costs.

This new form must now be used for all claims submitted for payment to Medicare, regardless of any entitlement to travel reimbursement. Any previous versions of the forms will be returned to you and not processed. Make sure that a claim & confirmation form for each review is attached to the cover sheet. If either the cover sheet and/or claim & confirmation form is not completed correctly it will be returned to you for amendment. Photocopies of completed forms will not be accepted for payment and will be returned to you. Copies of all forms submitted to Medicare must be kept in the pharmacy for seven years.

 Does my pharmacy qualify for the HMR Rural Loading?

A HMR Rural Loading may be payable to pharmacies who are located within the Pharmacy Accessibility/Remoteness Index of Australia (PhARIA) categories 2, 3, 4, 5 or 6. This information can be obtained from the GISCA websiteExternal link. To qualify a distance of 10 kilometres or greater (return trip), measured from the approved pharmacy's principal place of business to the consumers' residence, must be undertaken. The Rural Loading payment is:

PhARIA Amount
2 $20
3 $30
4 $40
5 $50
6 $60
 A doctor has asked me to perform an HMR in a nursing home?

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.

 Can I perform an HMR by telephone?

There is no provision for telephone interviews.

 How much do pharmacies get paid?

Pharmacies receive $194.07 per review.

 Where can I get further supplies of claim forms?

Claim forms are available from this website, or hard copies are available by calling Medicare's Adelaide office, 08 8274 9641.

 How do I get paid?

Payments are made into the bank account where pharmacy prescription claims are paid.

 How can I contact Medicare for assistance with the HMR program?

The Adelaide office which administers the HMR program can be contacted by telephone on 08 8274 9641 or in writing by addressing the envelope to:

Community Pharmacy Agreement Officer
Medicare 
GPO Box 9826
Adelaide SA 5001 

or email sa.guild.govt.prog@medicareaustralia.gov.auEmail

Last updated: 27 September, 2013