The intent of the HMR Program is to support the quality use of medicines and assist minimising adverse medicine events by helping people to better understand and manage their medicines through a medication review conducted by an Accredited Pharmacist in the home.

COVID-19 UPDATE 
Please see the Telehealth section below or the HMR Program Rules for more information on temporary telehealth services during the COVID-19 pandemic.

A Home Medicines Review (HMR) is a clinical process that considers the Patient’s medicines and health in order to enhance the Quality Use of Medicines (QUM) and reduce the number of adverse medicines events. A General Practitioner (GP), Specialist in Pain Medicine, Specialist Physician, Specialist Psychiatrist or Specialist in Palliative Medicine may generate a HMR referral for their Patient. The Patient has a choice of whether this referral is provided to their usual Community Pharmacy or to another Service Provider (including a sole trader Accredited Pharmacist).

An HMR is a collaborative process between the referring Medical Practitioner (‘Referrer’), the GP (if this is not the Referrer), other members of the Patient’s healthcare team (including the Patient’s usual Community Pharmacy if they have one), Accredited Pharmacist, Patient, and where appropriate, a carer.

During the HMR Interview process, the Accredited Pharmacist will aim to improve the Patient’s understanding of their medicines. After the initial Interview, the Accredited Pharmacist will produce a HMR Report that outlines their findings. The HMR Report aims to improve the Referrer’s understanding of how the Patient is using their medicines and provide recommendations that will assist the Referrer and Patient in developing a medication management plan. The Report will be provided to the Referrer, the GP (if not the Referrer), and any members of the Patient’s healthcare team as requested by the patient (including their usual pharmacy).The Report should also be uploaded to the Patient’s My Health Record (if the patient has one).

From 21 April 2020, if clinically indicated, up to two follow-up service(s) can be conducted, with a focus on the resolution of medication-related problems identified at the initial Interview.

If required, a first face-to-face follow-up Interview should be undertaken no earlier than one month and no later than nine months after the initial Interview.

If a second face-to-face follow-up Interview is required, it should be undertaken no earlier than one month after the first follow-up Interview and no later than nine months after the initial Interview.

An indication of whether follow-up service(s) are required should be included in the HMR Report following the initial Patient Interview.

Home Medicines Review Eligibility

S90 Community Pharmacies and business entities that have a relationship with an Accredited Pharmacist (including sole traders) may register to become an Approved Service Provider, providing they meet all eligibility requirements and agree to abide by the Pharmacy Programs Administrator General Terms and Conditions and undertake HMR Services in accordance with the HMR Program Rules and the PSA Standards. Service Providers can register for the Program on the Pharmacy Programs Administrator Portal.

Patients are eligible to participate in a HMR if they meet the following eligibility criteria:

  • They hold a current Medicare card or Department of Veterans’ Affairs (DVA) card
  • They live in a community setting
  • They are at risk of, or experiencing, medication misadventure
  • The Referring Medical Practitioner confirms that there is an identifiable clinical need for a HMR Service.

A patient is not eligible for an HMR Service if they are currently an in-patient at a public hospital, private hospital, day hospital facility, transition care facility or if they are a resident of an Aged Care Facility.

There are two types of Program Variations that may be requested by the Service Provider (further details about each are provided below). These are:

  • Location of HMR Interview
  • HMR Interview conducted by a Registered Pharmacist.

The Service Provider must submit a Program Variation request through the Pharmacy Programs Administrator Portal at least 10 working days prior to the proposed date of the Initial HMR Interview. Requests will be forwarded by the Pharmacy Programs Administrator to the Australian Government Department of Health to assess based on the evidence provided. The Pharmacy Programs Administrator will advise the Service Provider of the outcome via email within seven working days from the date of submission. Additionally, Service Providers will be able to see the approval status of their Program Variation request on the Pharmacy Programs Administrator Portal.

In the event that a Program Variation is approved for a HMR Service, this approval will apply to any follow-up service(s) undertaken in relation to the initial face-to-face Interview. However, if the initial Interview has been undertaken in the Patient’s home, any follow-up Interviews must also be in the Patient’s home and no requests can be lodged.

Prior to submitting a Program Variation, the Service Provider must discuss the Program Variation process with the Patient. Consent must be sought from the Patient and Registered Pharmacist (if relevant) for their details to be provided in the Program Variation request to the Australian Government Department of Health and the Pharmacy Programs Administrator.

Service Providers who conduct Patient Interviews outside a Patient’s home or by using a Registered Pharmacist without prior approval will not be remunerated for those HMR Services. Approval will not be granted retrospectively. Receiving prior approval in either situation should not be construed as a guarantee that any future application, even for identical circumstances, will be approved.

Location of Patient Interview

The HMR Interview is a face-to-face interaction between the Accredited Pharmacist and the Patient. This must occur in the Patient’s home, except in the following circumstances:

  • For cultural reasons as specified by the Patient
  • If there are concerns about the safety of the Pharmacist relating to being inside the Patient’s home.

In circumstances where the HMR Interview cannot occur in the Patient’s home due to either of the above reasons, the Service Provider must submit a Program Variation request for an alternative location to be eligible for remuneration under the HMR Program. Approval will not be granted in instances where an alternative location is sought for the convenience or business practices of the Accredited Pharmacist or their employer. Prior approval must be obtained prior to the initial interview commencing.

If such a Program Variation is approved, it applies to any follow-up services undertaken in relation to the initial HMR Interview.

Interview Conducted by Registered Pharmacist

A Program Variation may also be sought for a Registered Pharmacist to conduct the initial HMR Interview in the Patient’s home, in the instance where an Accredited Pharmacist is not available to conduct the Interview. If such a variation is approved, it applies to any follow-up services undertaken in relation to the initial HMR Interview.

A Registered Pharmacist proposing to conduct the initial HMR Interview outside the Patient’s home must submit Program Variation requests for both the location of the Patient Interview and for an Interview conducted by a Registered Pharmacist.

Claiming

From 1 March 2020, Service Providers and Accredited Pharmacists are subject to a service cap of 30 HMR Services per calendar month. The service cap applies to both the Service Provider claiming the services, and the individual Accredited Pharmacist who provides the service.

Claim Submission

HMR initial services and follow-up services must be claimed via the Pharmacy Programs Administrator Portal by the end of the next calendar month after the initial Interview or follow-up Interview was conducted (e.g. Interviews undertaken in March must be claimed by 30 April).

Claims that are outside this timeframe, that are incomplete, or that do not meet Program Rules cannot be submitted and will not be paid.

Claims that exceed either the Service Provider or the Accredited Pharmacist’s monthly cap of 30 HMR Services also cannot be submitted and will not be paid.

Payments

Service Providers can claim the following payments under the Program:

Description Fee (per patient)
Provision of initial HMR Service (includes the initial Interview, assessment and HMR Report)  $222.77
First follow-up service  $111.39
Second follow-up service $55.70

The HMR Rural Loading Allowance aims to facilitate access to HMR services for Patients who live in rural or remote areas. During the provision of a HMR service, the Accredited Pharmacist may have to travel significant distances to conduct the HMR Interview(s) in the Patient’s home.

The Rural Loading Allowance funds up to $125 (GST exclusive) to contribute towards the travel costs incurred by the Pharmacist in travelling to the Patient’s home. This Allowance is designed to contribute to the costs involved and may not cover all such costs. Eligibility for the Allowance is based on the location of the Patient.

HMR Rural Loading Allowance Eligibility

In order to apply for the HMR Rural Loading Allowance, the applicant must:

  • Be an Approved HMR Service Provider
  • Have been provided with the signed HMR referral directly from the Patient’s Referrer
  • Provide the Interview (either initial Interview or follow-up Interview) at the Patient’s home, unless a Program Variation was requested and approved for the Interview to occur in a different location (see Program Variations above)
  • Provide evidence that the Accredited Pharmacist travelled to the Patient’s home to conduct a HMR Interview, and returned to the original starting address
  • Provide evidence that the round trip undertaken was 200 km or greater
  • Consent to the disclosure of personal information and its use in the evaluation, monitoring and management of the Allowance.

Applying for the Rural Loading Allowance

Service Providers will need to register and apply for the HMR Rural Loading Allowance via the Pharmacy Programs Administrator Portal. As the Allowance is an initiative of the HMR Program, Service Providers need to register and be approved for the HMR Program in order to be eligible to register and apply for the HMR Rural Loading Allowance.

The HMR Rural Loading Allowance claim must be submitted by the same Service Provider who submitted the associated HMR Service claim(s).

HMR Services should, where possible, be provided in a Patient’s home.

However, in response to the COVID-19 pandemic, HMRs may temporarily be undertaken via telehealth where a Patient meets any of the following eligibility criteria:

  • Meets the current national triage protocol criteria for suspected COVID-19 infection after consultation with either the national COVID-19 hotline, relevant state COVID-19 hotline, a registered medical or nursing practitioner or COVID-19 trained health clinic triage staff;
  • is aged over 70;
  • identifies as an Aboriginal and Torres Strait Islander person and is aged over 50;
  • has a chronic health condition or is immunocompromised; or
  • is pregnant, or a parent with a new baby.

Telehealth services are the preferred approach for substituting a face-to-face consultation however, if video is not available, Service Providers will also be able to offer audio-only services via telephone.

In the case where a Patient is isolating themselves at home on the advice of a medical practitioner for confirmed COVID-19 cases, it is recommended that the referring medical practitioner be contacted to confirm whether or not a service is still clinically appropriate and, if so, the service may be undertaken remotely.  It should be noted that a patient’s ability to participate in a service may be impacted and this should be taken into consideration.

The Department of Health has partnered with the Pharmaceutical Society of Australia to develop resources for delivering comprehensive medication reviews without a face-to -face Interview.

Telehealth

  1. If the Patient does not meet any of the above eligibility criteria, then the HMR Interview(s) must still be undertaken face-to-face in the Patient’s home in order to be claimed under the program.

  2. Yes; the Patient must provide either verbal or written consent in order for you to disclose their personal information to the PPA and Australian Government, and to the Patient’s Community Pharmacy or members of their healthcare team if required as part of the HMR Service.

    You must not pass submit a claim to the Pharmacy Programs Administrator (PPA) Portal if you do not have the patient’s verbal or written consent to do so.

    A consent form is available under the Resources section below that covers both types of consent.

    Some patients may prefer to read the consent form and electronically sign or print and sign the form and email it back to you rather than provide verbal consent. It is the patient’s choice whether they provide verbal or written consent.

    Please note as verbal consent is only temporarily allowed during the COVID-19 pandemic the PPA Portal claim form will still have the question asking if Written Patient Consent is held. If verbal consent is held during this time please select ‘Yes’.

Home Medicines Review FAQ

  1. A HMR referral can be written by any of the following types of medical practitioners registered with the Medical Board of Australia:

     – General Practitioner (GP)

    – Specialists in Pain Medicine;

    – Specialist Physicians;

    – Specialist Psychiatrists; or

    – Specialists in Palliative Medicine.

  2. A HMR Service consists of a Patient Interview, clinical assessment and written initial HMR report provided to the Referrer, the GP (if this is not the Referrer) and the Patient’s choice of Community Pharmacy (if relevant) with input from the multidisciplinary team and up to two HMR follow-up services if clinically indicated.

  3. From 21 April 2020, if clinically indicated, up to two follow-up service(s) can be conducted, with a focus on the resolution of medication-related problems identified at the initial Interview.

    A follow-up service will follow a similar, but less complex, process to the initial Patient Interview.

    Further information on what should be included in the follow-up service can be found in the Guidelines for Comprehensive Medication Management Reviews (PSA Standards).

  4. If required, the first face-to-face follow up Interview with the Patient (and their carer, if required) should take place no earlier than one month and no later than nine months after the initial Interview. Written correspondence should be forwarded to the Referrer, and other relevant members of the patient’s healthcare team (with patient’s consent) and include an indication of whether a second follow-up Interview is clinically indicated.

    If required, the second face-to-face follow up Interview with the Patient (and their carer, if required) should take place no earlier than one month after the first follow-up Interview, and no later than nine months after the initial Interview. Written correspondence should be forwarded to the Referrer, and other relevant members of the patient’s healthcare team (with patient’s consent).

    In both cases, the written record of the follow-up and any actions or recommendations should also be uploaded to the Patient’s My Health Record (if the Patient has one).

  5. No; a referral is not required to conduct a follow-up service. However, an indication of whether or not a follow-up is recommended should be included in the HMR Report provided to the Referrer after the Initial Patient Interview.

  6. If a new initial Patient Interview from a subsequent HMR referral has taken place, then claims for follow-up service(s) associated with the older HMR referral cannot be submitted in the PPA Portal. Follow-up(s) can only be conducted on the most recent HMR referral. 

    Information such as the date and Service Provider who conducted the last HMR Service cannot be made available in the PPA service history checker due to privacy concerns.

    It is therefore important that Service Providers communicate with the Patient and Referrer to ensure a more recent HMR Patient Interview has not taken place prior to undertaking any follow-up services.

  7. From 1 March 2020 the cap for HMRs is 30 per month for both the Service Provider claiming and the Accredited Pharmacist conducting the Service (irrespective of how many Service Providers they provide HMR Services on behalf of).

    Please note that once an Accredited Pharmacist has conducted more than 30 HMRs, additional HMR services they conduct cannot be claimed for, regardless of if the Service Provider making the claim has not yet reached their own Service Provider cap. Follow-up services do not count towards this restriction.

  8. No; only the initial HMR Review (which includes the initial Interview, assessment and HMR Report) will count towards the monthly cap of 30. Follow-up services are classified as part of the HMR Service therefore any follow-ups undertaken are not counted separately towards your monthly cap.

  9. Yes, if you are an Accredited Pharmacist.

    You must also have an active ABN to register as a Service Provider on the PPA Portal.

    Remember though, that any Service you perform for another Service Provider will count towards your personal pharmacist cap of 30.

  10. The same Accredited Pharmacist must conduct the initial Patient Interview, assessment and HMR Report and should ideally conduct any associated follow-up services.

    A Registered Pharmacist may be permitted to conduct the initial Patient Interview step of the HMR Service under very limited circumstances. This requires prior approval (see Program Variations in the HMR Program Rules for further information).

    Where it is not possible for the same Accredited Pharmacist to undertake the follow-up services, an alternative Accredited Pharmacist may undertake these, if required, in collaboration with the Accredited Pharmacist who completed the initial Patient Interview and HMR Report and the health care team.

    Where it is not possible for an alternative Accredited Pharmacist to undertake follow-up services, a registered pharmacist may undertake follow-up services, in collaboration with the Accredited Pharmacist who completed the initial Patient Interview and HMR Report and the health care team.

  11. The HMR Service Provider in receipt of the referral must lodge the claim for payment following both the Initial Interview and any required follow-up services.

    This means if you are an Accredited Pharmacist and you intend to claim for the HMR Service as a Sole Trader, the HMR Referral should be written directly to you. A Community Pharmacy or Business Entity (other than a Sole Trader) may claim for a HMR Service performed by any Accredited Pharmacist they have a relationship with, providing the referral was written to the Community Pharmacy or Business Entity (rather than to a specific Accredited Pharmacist). For further details on who is eligible to register and claim as a Service Provider please see the HMR Program Rules.

  12. This is up to you and is dependent on how your business is set up. If you are all Sole Traders, you may choose to register yourselves separately as individual Service Providers. The monthly cap of 30 HMRs will apply to each individual Service Provider.

    If you are not Sole Traders, you may choose to register yourselves as a Service Provider together as a Business if this is how you operate. There will need to be one main authorised person who will be the only person able to change bank details and contact details of the Service Provider on the PPA Portal. If others in the Business are approved as authorised contacts, they will be able to submit claims on behalf of the Business. Please note the monthly claiming cap of 30 HMRs will still apply to this type of Service Provider, regardless of how many Pharmacists are providing services on behalf of the Service Provider.

    If you are only providing services on behalf of a Community Pharmacy, the Community Pharmacy must register as a Service Provider to submit the HMR Service claims.

  13. Initial HMR services and follow-up services must be claimed by the end of the next calendar month after the initial Interview or follow-up Interview was conducted e.g. a Service completed on 21/04/2020 should be submitted by 31/5/2020. For claiming purposes, the Service date entered in the PPA Portal should be the date you conducted the Patient Interview.

  14. A separate claim entry will need to be made for each individual HMR Service conducted.

    You may choose to wait until you have conducted all HMR Services for that month and submit them all on the same day or you may choose to submit them separately once you have completed each HMR Report. This is up to you, so long as each HMR Service is claimed by the end of next calendar month following the date you undertook the Patient Interview.

  15. No. A claim for each Interview must be submitted by the end of the next calendar month after it occurs. Follow-up interviews can occur up to nine months after the initial Interview.

  16. No; You must have an approved initial HMR Service claim in the PPA Portal in order to submit any associated follow-up service claims.

  17. No; You must have successfully claimed for both the initial HMR Service and the associated first follow-up service in order to submit a claim for any associated second follow-up service.

  18. Follow-up services can only be conducted and submitted for the most recent HMR Service.

    If the follow-up service you are trying to claim for was undertaken after a more recent initial HMR service (based off a new HMR Referral) has been undertaken and claimed by either yourself or another Service Provider, you will not be able to claim for that follow-up service.

    Information such as the date and Service Provider who conducted the last HMR Service cannot be made available in the PPA service history checker due to privacy reasons. It is therefore important that Service Providers communicate with the Patient and Referrer to ensure a more recent HMR Patient Interview has not taken place prior to undertaking any follow-up services.

  19. You have 90 days to complete the HMR Interview; however, if you are unable to perform the Interview within 14 days of receiving the referral you should contact the Referrer and discuss when the service will happen.

  20. No; however, you will be required to confirm you hold written Patient consent. The Patient Consent Form is to be kept on your records for seven years for auditing purposes.

  21. Yes, as the HMR Service consists of a Patient Interview, clinical assessment and written HMR report, the claim can only be submitted if the HMR Report has been sent to the Referrer. As the HMR service also includes any follow-up interviews, written correspondence should also be provided to the Referrer following a follow-up.

    Any written correspondence from the initial HMR report and follow-up service(s) should also be uploaded to the patient’s My Health Record (if the patient has one).

  22. A Registered Pharmacist can conduct the HMR initial Interview step of the HMR Service if the Service Provider is unable to source an Accredited Pharmacist to conduct the Interview however, a Program Variation must be requested through the Pharmacy Programs Administrator Portal at least 10 days prior to the Interview. If a request is not submitted or a request is submitted and subsequently rejected, and a Registered Pharmacist conducts the Interview, the claim will not be paid. An Accredited Pharmacist must still assess the information attained and write the HMR Report.

    A Registered Pharmacist may also conduct follow-up services in collaboration with the Accredited Pharmacist and the health care team when it is not possible for an Accredited Pharmacist to undertake the follow-up services.

  23. Yes, where possible, to ensure the effectiveness of the Service the Interview should be held at the Patient’s home. If entering the Patient’s home is not possible due to either cultural or safety concerns, then a Program Variation can be requested to complete the Interview outside the home. A Program Variation must be requested through the Pharmacy Programs Administrator Portal at least ten days prior to the Interview.

    See the telehealth section above for changes allowed during the COVID-19 pandemic.

  24. Details about Program Variations (also known as Prior Approvals) can be found in the HMR Program Rules. Program Variation requests are required to be submitted through the Pharmacy Programs Administrator Portal at least 10 days before the intended Patient Interview. The Pharmacy Programs Administrator will forward this request to the Department. The request will be approved or declined and the outcome will be provided to you within seven days of the request being submitted in the PPA Portal. Please note that approval is required before completing the Service and retrospective approval will not be granted.

    In the event that a Program Variation is approved for a HMR Service, this approval will apply to any follow-up service(s) undertaken in relation to the initial face-to-face Interview.

     

     

  25. No. If the Initial Interview has been undertaken in the Patient’s home, any follow-up Interview(s) must also be in the Patient’s home, and no requests for Program Variation can be lodged.

  26. Yes; however, a request will need to be submitted for both types of Program Variations. In the event that a Program Variation is approved for the initial Interview to be undertaken by a Registered Pharmacist, this approval will apply to any follow-up service(s) undertaken in relation to the initial face-to-face Interview.

    See the telehealth section above for changes allowed during the COVID-19 pandemic.

  27. Each Patient is allowed to have a HMR Service once every 24 months. However, if a Referrer believes that another HMR is clinically necessary within the 24 months, for example in circumstances where there has been a significant change to the Patient’s condition or medication regimen, more Services can be performed and claimed. Please note though, that Services are intended to only be conducted when required and must not be triggered solely by an ‘anniversary’ date.

  28. Please refer to the HMR RLA Portal User Guide.

  29. Payments are up to $125 (GST exclusive) for each HMR RLA claim. This is regardless of the distance travelled or number of HMRs performed on your round trip.

  30. Yes; the rural loading allowance can be claimed for follow-up service(s). Please note the same eligibility criteria still applies such as: location of the Interview, distance travelled etc.

  31. No, only an approved HMR Service Provider is able to submit a HMR Service claim; therefore, it must be the same HMR Service Provider who makes the associated HMR RLA claim as this is essentially an extension of the HMR Program. If you have conducted the HMR Services but are not making the HMR claims you may need to discuss this with the Service Provider to see if they can submit the HMR RLA claim on your behalf.

  32. No, but you will have to provide tax invoices for your travel. Payments are still up to $125 (GST exclusive) regardless of your mode of transport.

  33. The distance travelled to undertake HMR Service(s) must be at least 200km as a round trip in order to apply for the HMR RLA. The round trip claimed must have been undertaken in order to provide one or more HMR Interviews (includes initial HMR Interviews and follow-up Interviews).

  34. Yes, you may conduct as many as you like (up to the HMR cap of 30 initial HMR Interviews per month). Remember if you have conducted multiple HMRs on your trip you will need to enter into your HMR RLA application the associated HMR Service claim ID number for each HMR you conducted.

  35. Yes, to ensure safety the start and end dates of the HMR RLA claim can be on consecutive days, remembering the claim must still be for a round trip.

  36. No, the travel must be a round trip, starting and finishing at the same address.

  37. Yes; however, the flight distance must be at least 350 kms to be eligible for the HMR RLA.

  38. A Patient must be located in a PhARIA 2 to 6 location for a HMR RLA claim to be eligible. PhARIA information can be found here.

  39. Yes, if the Patient’s home(s) you are travelling to are located in a PhARIA 2 to 6 location. Eligibility for the Allowance is based on the Patient’s location, not the Service Provider’s location.

  40. No, follow-up services are pharmacist initiated and do not require a referral by a medical practitioner.  The PPA cannot provide specific information on MBS items as we do not administer the Medicare Benefits Schedule. Pharmacists and GPs with MBS item questions will instead need to contact the administrator of the Medicare Benefits Schedule, Services Australia.  

  41. The PPA cannot provide specific information on MBS items as we do not administer the Medicare Benefits Schedule. Pharmacists and GPs with MBS item questions will instead need to contact the administrator of the Medicare Benefits Schedule, Services Australia.