HF 1606

as introduced - 87th Legislature (2011 - 2012) Posted on 04/28/2011 09:58am

A bill for an act
relating to human services; expanding a medication therapy management
demonstration project to provide culturally specific care; establishing a
medication reconciliation demonstration program; amending Minnesota Statutes
2010, section 256B.0625, subdivision 13h.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2010, section 256B.0625, subdivision 13h, is amended
to read:

Subd. 13h.

Medication therapy management services.

(a) Medical assistance and
general assistance medical care cover medication therapy management services for a
recipient taking deleted text begin four or more deleted text end prescriptions to treat or prevent deleted text begin two deleted text end new text begin one new text end or more chronic
medical conditions, or a recipient with a drug therapy problem that is identified or prior
authorized by the commissioner that has resulted or is likely to result in significant
nondrug program costs. The commissioner may cover medical therapy management
services under MinnesotaCare if the commissioner determines this is cost-effective. For
purposes of this subdivision, "medication therapy management" means the provision
of the following pharmaceutical care services by a licensed pharmacist to optimize the
therapeutic outcomes of the patient's medications:

(1) performing or obtaining necessary assessments of the patient's health status;

(2) formulating a medication treatment plan;

(3) monitoring and evaluating the patient's response to therapy, including safety
and effectiveness;

(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;

(5) documenting the care delivered and communicating essential information to
the patient's other primary care providers;

(6) providing verbal education and training designed to enhance patient
understanding and appropriate use of the patient's medications;

(7) providing information, support services, and resources designed to enhance
patient adherence with the patient's therapeutic regimens; and

(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.

Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.

(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:

(1) have a valid license issued under chapter 151;

(2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;

(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the
setting, or in home settings, excluding long-term care and group homes, if the service is
ordered by the provider-directed care coordination team; and

(4) make use of an electronic patient record system that meets state standards.

(c) For purposes of reimbursement for medication therapy management services,
the commissioner may enroll individual pharmacists as medical assistance and general
assistance medical care providers. The commissioner may also establish contact
requirements between the pharmacist and recipient, including limiting the number of
reimbursable consultations per recipient.

(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing
within a reasonable geographic distance of the patient, a pharmacist who meets the
requirements may provide the services via two-way interactive video. Reimbursement
shall be at the same rates and under the same conditions that would otherwise apply to
the services provided. To qualify for reimbursement under this paragraph, the pharmacist
providing the services must meet the requirements of paragraph (b), and must be located
within an ambulatory care setting approved by the commissioner. The patient must also
be located within an ambulatory care setting approved by the commissioner. Services
provided under this paragraph may not be transmitted into the patient's residence.

(e) The commissioner shall establish a pilot project for an intensive medication
therapy management program for patients identified by the commissioner with multiple
chronic conditions and a high number of medications who are at high risk of preventable
hospitalizations, emergency room use, medication complications, and suboptimal
treatment outcomes due to medication-related problems. For purposes of the pilot
project, medication therapy management services may be provided in a patient's home
or community setting, in addition to other authorized settings. The commissioner may
waive existing payment policies and establish special payment rates for the pilot project.
The pilot project must be designed to produce a net savings to the state compared to the
estimated costs that would otherwise be incurred for similar patients without the program.
The pilot project must begin by January 1, 2010, and end June 30, 2012.

new text begin (f) Beginning January 1, 2012, the commissioner of human services shall expand the
pilot project established under paragraph (e) to allow an organization with experience in
providing culturally specific medication therapy management services to American Indian
and other medically underserved communities to contract with pharmacists meeting the
requirements in paragraph (b) to provide medication therapy management services to
enrollees who are American Indian or from underserved communities experiencing health
disparities. The standards and patient eligibility criteria for the original demonstration
project established under paragraph (e) shall otherwise apply, except that the organization
may modify patient eligibility criteria for medication therapy management and may
provide medication therapy management services under this paragraph through June
30, 2014.
new text end

Sec. 2. new text begin MEDICATION RECONCILIATION DEMONSTRATION PROJECT.
new text end

new text begin (a) The commissioner of health shall establish a two-year medication reconciliation
demonstration project to evaluate the quality and effectiveness of various methods
of providing pharmacy-based medication histories, documentation, and medication
reconciliation.
new text end

new text begin (b) The commissioner shall request proposals from hospitals or health care systems
to implement, beginning January 1, 2012, medication reconciliation projects. The
projects may incorporate innovative practice roles for pharmacists, pharmacy interns,
and pharmacy technicians. Applicants must submit proposals to the commissioner by
September 1, 2011. A proposal must specify the method for providing or compiling
medication histories, documentation, and medication reconciliation, define the duties of
health care professionals, and incorporate an evaluation process.
new text end

new text begin (c) The commissioner shall establish a medication reconciliation task force to
assist the commissioner in reviewing project applications and working with the hospital
or health system to implement approved projects. The task force shall consist of one
representative from each of the following organizations: the Minnesota Board of
Pharmacy, the Minnesota Hospital Association, the Minnesota Medical Association, the
Minnesota Pharmacists Association, and the Minnesota Society of Hospital Pharmacists.
new text end

new text begin (d) Hospitals or health care systems implementing a project must submit a
progress report to the commissioner and the medication reconciliation task force by
November 1, 2012, and a final report by December 1, 2013. The task force shall present
recommendations on whether the demonstration project should be continued or expanded
to the commissioner of health, the Minnesota Board of Medical Practice, the Minnesota
Board of Nursing, and the Minnesota Board of Pharmacy by January 15, 2014.
new text end