Residential Medication Management Review and QUM

Residential Medication Management Reviews have been designed to enhance the quality use of medicines for consumers in approved Australian Government funded aged care facilities, by assisting consumers and their carers to better manage their medicines. The programme will also support activities that are designed to improve quality use of medicines across approved Australian Government funded aged care facilities through the QUM component of the programme.

A Residential Medication Management Review (RMMR) is a service provided to a permanent resident of an Australian Government funded aged care facility. It is conducted by an accredited pharmacist when requested by a resident’s general practitioner (GP) and undertaken in collaboration with the resident’s GP and appropriate members of the resident’s healthcare team. A comprehensive assessment is undertaken to identify, resolve and prevent medication-related problems and is provided to the resident’s GP.

Residents in flexible care arrangements and transitional care facilities are also eligible for RMMRs.

The QUM service is a separate service provided by a registered or accredited pharmacist and focuses on improving practices and procedures as they relate to the quality use of medicines in a residential care facility.

Participation

Residential Medication Management Review

In order to be an approved RMMR Service Provider, the applicant must:

  • be the owner of an approved Section 90 pharmacy; or
  • be a business entity, with an Australian Business Number (ABN), this includes an accredited pharmacist operating as a sole trader; and
  • hold a current valid RMMR Service Agreement with an Australian Government funded aged care facility for RMMR services to be provided in that facility.

For a patient to be eligible for an RMMR service, they must be:

  • a current Medicare/Department of Veterans’ Affairs (DVA) cardholder; and
  • be at risk of, or currently experiencing, medication misadventure; and
  • a permanent resident of:
    • an Australian Government funded aged care facility as defined by the Aged Care Act 1997; or
    • a Multi Purpose Service facility; or
  • be a resident in an Australian Government funded transition care facility for more than 14 consecutive days; and
  • the GP confirms that there is an identifiable clinical need that the patient will benefit from a RMMR service.
QUM

In order to be an approved QUM Service Provider, the applicant must:

  • be the owner of an approved Section 90 pharmacy; or
  • be a business entity, with an Australian Business Number (ABN), this includes an accredited pharmacist operating as a sole trader; and
  • hold a current valid QUM Service Agreement with an Australian Government funded aged care facility for QUM services to be provided in that facility.

Claiming and Payments

RMMR Claim Submission

Claims must be submitted via the 6CPA Registration and Claiming Portal within 30 days from the date of service (patient interview).  Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

QUM Claim Submission

Claims must be submitted via the 6CPA Registration and Claiming Portal within 30 days from the end of each claiming quarter.  Claims submitted outside this timeframe will be not be paid and cannot be resubmitted.

RMMR and QUM Claim Amendments

Claims that are submitted with incomplete information or incorrect Patient or Service Provider details will be required to be amended within thirty (30) days of the amendment notification. Claims that are not amended within thirty (30) days of the amendment notification will not be paid.

Claims that are submitted outside the required timeframe (within 30 days from the date of service) cannot be resubmitted.

Claims submitted that exceed a Service Provider’s monthly cap of twenty (20) HMR services will not be paid and cannot be resubmitted.

RMMR Payments

Services are payable to approved service providers for each RMMR conducted after a referral by a GP. The payment rate for an RMMR service conducted on or after the 1st July 2015 is $106.66.