PROFESSIONAL DEVELOPMENT

PHARMACIST-LED MEDICATION THERAPY MANAGEMENT

FARAH JALLOUL

BY FARAH JALLOUL, Pharm.D., MBA, director of professional development, Michigan Pharmacists Association

Pharmacists today are actively participating in direct patient care activities due to the increasing complexities of modern medication therapies. Medication therapy management (MTM) services are pharmacist-led consultations that optimize drug therapy and improve therapeutic outcomes of patients. All Michigan Medicaid beneficiaries (including both fee-for-service and managed care and excluding Medicare Part D) have been eligible for MTM services since April 1, 2017. These activities go beyond saving healthcare dollars; they improve and even save patients’ lives. MTM services focus on the patient rather than the product. Medication management services strive to improve collaboration among the various healthcare professions while optimizing medication usage and patient-centered outcomes.

THE BENEFITS OF MEDICATION THERAPY MANAGEMENT

Clinical Service: Pharmacists help patients effectively manage all their medications and treatments through one-on-one counseling, collaboration with other healthcare professionals and follow up.

Safety: MTM keeps patients safe by minimizing interactions and ensuring all medications are appropriate.

Patient-centered: MTM aids pharmacists in enabling their patients to take control of their medication(s), therapy goals and overall health with confidence.

Cost Savings: MTM is proven to help patients reduce their healthcare costs, because improving patient health prevents future healthcare issues.

Eligible patients: A beneficiary is eligible for MTM services if they are receiving at least one medication used to treat or prevent one or more chronic conditions as identified in the Chronic Conditions for Medication Therapy Management Benefit Eligibility list. Note: at least one diagnosis code on an MTM claim must be a diagnosis code from the list of chronic conditions for MTM eligibility.

Eligible MTM providers: To be eligible for MTM services reimbursement, pharmacists must first complete an MTM program approved by the Accreditation Council of Pharmacy Education (ACPE), such as the Michigan Pharmacists Association’s (MPA’s) ACPE-approved program “Delivery of MTM Services for Michigan Medicaid Beneficiaries” or complete the American Pharmacists Association’s “Delivering Medication Therapy Management Services” certificate program.

Enrolling in CHAMPS: After completing the MTM training, pharmacists must enroll in the Community Health Automated Medicaid Processing System (CHAMPS). CHAMPS is the web-based Michigan Department of Health and Human Services (MDHHS) Medicaid claims processing system. To billfor MTM services rendered, pharmacists must enroll in CHAMPS using their pharmacist national provider identifier (NPI) number and affiliate themselves with the Billing NPI of a pharmacy, Federally Qualified Health Center (FQHC), Tribal Health Center (THC) or a rural health clinic (RHC). To begin the CHAMPS enrollment process, visit www.Michigan.gov/MedicaidProviders and click on Provider Enrollment. For additional assistance regarding enrollment, providers may contact the CHAMPS Provider Support at 1-800-292-2550 or ProviderSupport@michigan.gov.

Telephonic MTM Services: Once enrolled in CHAMPS, pharmacist-led MTM services can be provided in an ambulatory care outpatient setting, a clinic, a pharmacy or the beneficiary’s home if the beneficiary does not reside in a non-covered service setting. MTM services are intended to be provided face-to-face, however, due to COVID restrictions, Medicaid Medical Services Administration (MSA) bulletin 20-12 and MSA 20-13 authorize the telephonic delivery of the service.

CHAMPS Billing: Note that a “02” must be used as a place of service identifier along with a GT interactive modifier code of GT0780 for telephonic MTMs. In addition, the claim notes section must state that the “service was provided telephonically.”

Pharmacists can bill Medicaid’s CHAMPS system using the current procedural terminology (CPT) billing codes identified under Table 1. Note that each CPT Code is billed for a 15-minute increment. CPT Code 99607 allows for additional 15-minute increments that can be dual billed with either CPT Code 99605 or 99606.

For questions regarding Medicaid MTM, membership can contact MPA Director of Professional Development Farah Jalloul at Farah@ MichiganPharmacists.org.