HF 2307

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:01am

A bill for an act
relating to human services; establishing an intensive medication therapy
management pilot project; amending Minnesota Statutes 2008, section
256B.0625, subdivision 13h.

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

Section 1.

Minnesota Statutes 2008, 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 four or more prescriptions to treat or prevent two 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.

deleted text begin (d) The commissioner, after receiving recommendations from professional medical
associations, professional pharmacy associations, and consumer groups, shall convene
an 11-member Medication Therapy Management Advisory Committee to advise
the commissioner on the implementation and administration of medication therapy
management services. The committee shall be comprised of: two licensed physicians;
two licensed pharmacists; two consumer representatives; two health plan company
representatives; and three members with expertise in the area of medication therapy
management, who may be licensed physicians or licensed pharmacists. The committee is
governed by section 15.059, except that committee members do not receive compensation
or reimbursement for expenses. The advisory committee expires on June 30, 2007.
deleted text end

deleted text begin (e) The commissioner shall evaluate the effect of medication therapy management
on quality of care, patient outcomes, and program costs, and shall include a description
of any savings generated in the medical assistance and general assistance medical care
programs that can be attributable to this coverage. The evaluation shall be submitted to
the legislature by December 15, 2007. The commissioner may contract with a vendor
or an academic institution that has expertise in evaluating health care outcomes for the
purpose of completing the evaluation.
deleted text end

new text begin (d) 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.
new text end