Residential Medication Management Review and Quality Use of Medicines

Residential Medication Management Reviews (RMMRs) are aimed at improving the Quality Use of Medicines (QUM) for Patients who live in an approved Australian Government-funded Facility.

Quality Use of Medicine Programs support the delivery of services and activities that improve medicines safety, delivery, and utilisation within Australian Government- funded Aged Care Facilities.

A Residential Medication Management Review (RMMR) is a service provided to a permanent resident of an Australian Government funded Facility. A Pharmacist accredited to provide RMMR services will conduct a RMMR for a Patient when requested to do so by that person’s General Practitioner (GP). This review will be conducted in collaboration with the Patient’s GP and appropriate members of their healthcare team.

The RMMR consists of a comprehensive assessment of the Patient’s medications and medication-related health care interventions, with the purpose of identifying, resolving, and preventing medication related problems. This process will generate a report that is provided to the Patient’s GP for consideration of the issues raised.

A Patient may be eligible for a RMMR while residing in a Facility that receives Australian Government funding. This eligibility extends to people who have flexible care arrangements or are utilising a transitional care facility.

The Quality Use of Medicines service is a separate service provided by a Registered or Accredited Pharmacist. This service is designed to improve procedures and practices related to Quality Use of Medicines within Australian Government-funded Facilities.

RMMR

In order to be an approved RMMR Service Provider, the applicant will meet the following criteria:

  • Have in place a current valid RMMR Service Agreement with an Australian Government-funded Aged Care Facility that sets out the provision of RMMR services to that facility; and
  • Own 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.

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

  • A permanent resident of an Australian Government-funded Aged Care Facility as defined by the Aged Care Act 1997; or
  • A permanent resident of a Multi Purpose Service Facility; or
  • A resident in an Australian Government-funded transition care facility for more than 14 consecutive days.

In addition, the person must be:

  • A current Medicare/Department of Veterans’ Affairs (DVA) cardholder
  • Currently experiencing or at risk of experiencing medication-related adverse outcomes
  • The person’s GP must confirm that the person will benefit from an RMMR service due to an identifiable clinical need.

Full participation requirements are outlined in the Residential Medication Management Review Program Rules.

QUM

In order to be an approved Quality Use of Medicines Service Provider, the applicant will meet the following criteria:

  • Have in place a current valid QUM Service Agreement with an Australian Government-funded Aged Care Facility that sets out the provision of QUM services to that facility
  • Own an approved Section 90 Pharmacy
  • Be a business entity, with an Australian Business Number (ABN). This includes an Accredited Pharmacist operating as a sole trader.

Full participation requirements are outlined in the Quality Use of Medicines Program Rules.

RMMR and QUM Contract Verification

A copy of a completed service agreement between the service provider and the Aged Care Facility must be supplied to the Pharmacy Program Administrator for verification in order to claim for RMMR and QUM Services. These must be submitted online via the Pharmacy Programs Administrator Portal.

The Pharmacy Program Administrator must be notified if the contract between the service provider and the Aged Care Facility is cancelled or expires.

RMMR Claim Submission

Claims for RMMR services provided to a person who is eligible to receive an RMMR service must be submitted for payment by the end of the calendar month following the service (e.g. services provided in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

QUM Claim Submission

Claims for QUM services provided to an eligible Aged Care Facility must be claimed by the end of the month following the service period (e.g. a period that ends in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

RMMR and QUM Claim Amendments

In the instance where a claim is submitted that is incomplete, incorrect, or otherwise invalid, the service provider may re-submit the claim within 30 days of being notified that an amendment is required. Re-submitted claims that are received outside the required timeframe (within 30 days from the date of service) will not be accepted.

RMMR Payments

Pharmacists who provide eligible RMMR services are entitled to claim $111.09 for each service. This amount is indexed annually.

QUM Payments

Pharmacists who provide QUM services to an approved Facility must provide at least one QUM service each quarter. This entitles the provider to claim a base payment of $60 plus $6 per eligible aged care bed within the Facility each quarter.

Residential Medication Management Review FAQ

  1. No, the RMMR Program is not capped; however, services are intended to be performed only when identified as required by a General Practitioner (GP). One RMMR Service can be conducted per eligible Patient on referral from a GP. A subsequent RMMR Service may only be conducted if more than 24 months has elapsed since the date of the most recent Patient Interview, or when the Patient’s GP specifically deems a subsequent review is clinically necessary. Please note, provision of a subsequent RMMR must not be triggered solely by an ‘anniversary’ date; the service is not intended to be part of an ongoing review cycle.

  2. To be eligible to become an RMMR Service Provider you must be:

    • An owner of an approved Section 90 Community Pharmacy
    • A business entity with an Australian Business Number (ABN).  This includes an Accredited Pharmacist operating as a sole trader.

    Service Providers who are not eligible are:

    • Any organisation that is able to initiate a referral for the RMMR Service
    • A Section 94 Pharmacy
    • A public or private hospital.

    A RMMR Service Provider must have executed a RMMR Service Agreement with an eligible Aged Care Facility.  The RMMR Service must be delivered by an Accredited Pharmacist.

  3. Facilities that qualify for the RMMR Program are Australian government funded. This includes:

    • Aged Care Facilities that receive the residential care subsidy in accordance with the Aged Care Act 1997
    • Transition care facilities
    • Multi-purpose service facilities.

    Wholly privately-owned facilities are not eligible for the Program. 

  4. No, Facilities that qualify for the RMMR program are Australian government funded. This includes:

    • Aged Care Facilities that receive the residential care subsidy in accordance with the Aged Care Act 1997
    • Transition care facilities
    • Multi-purpose service facilities.

    Wholly privately-owned facilities are not eligible for the program. 

  5. To be eligible for a RMMR Service, the Patient must meet the following criteria:

    • The Patient is a current Medicare/DVA card holder
    • The Patient is at risk of, or currently experiencing, medication misadventure
    • The Patient is:
      • A permanent resident of an Australian Government funded Aged Care Facility, as defined by the Aged Care Act 1997 or
      • A permanent resident of a multi-purpose service facility or
      • A resident in an Australian Government funded transition care facility for more than 14 consecutive days
    • The GP confirms that there is an identifiable clinical need and that the Patient will benefit from a RMMR Service.
  6. The service must be performed by any Accredited Pharmacist employed or contracted by the Service Provider. If you intend to claim for the RMMR as a sole trader, the General Practitioner referral should be written directly to you.

  7. Yes; however, you must have an ABN to register for the Program and be an Accredited Provider, or employ or contract an Accredited Provider to deliver the service. Remember, though, that there must be an RMMR Service Agreement in place between yourself and the Facility before completing any RMMR Services.

  8. Yes, each Facility must only have one contracted RMMR Service Provider. You will not be able to submit a claim for RMMR service without first providing an executed Service Agreement (contract) between yourself and the Facility.

  9. Yes; however, each Facility must only have one contracted RMMR Service Provider and one contracted QUM Service Provider.

  10. A copy of the RMMR contract template is available from the Downloads section of this page.

  11. Yes, a new RMMR Service Agreement template is available from the Downloads section of this page.

  12. Yes, the Pharmacy Programs Administrator can inform you if a Facility has a contracted provider; however, for privacy reasons, we are unable to tell you the name of the contracted Service Provider.

  13. Existing contracts in place with Aged Care Facilities that were established and approved by the Pharmacy Guild, and have an end date on or after 1 February 2019, will continue to apply. 

    Existing Service Providers will not need to create new Service Agreements until the current Agreement expires. Service Providers establishing new Service Agreements can access the Service Agreement example template, available from the Downloads section of this page.

  14. No: existing contracts in place with Aged Care Facilities that were established and approved by the Pharmacy Guild prior to 1 February 2019, and have an end date on or after 1 February 2019, will continue to apply.  Existing Service Providers will not need to create new Service Agreements with Aged Care Facilities until their current contracts expire. Service Providers establishing new Service Agreements can access the Service Agreement example template, available from the Downloads section of this page.

  15. Yes: if you have extended an existing RMMR Service Agreement with an Aged Care Facility and need this reflected in the Portal, please email the Support Centre at support@ppaonline.com.au.  In your email please specify the Aged Care Facility name, the new Service Agreement end-date, and attach evidence of the extension.

    Please confirm new extension arrangements prior to the end of your current agreement and before you make a claim against the new contract period.

  16. You must log in and register as a Service Provider if you have not already registered and then register the Aged Care Facility in the Pharmacy Programs Administrator Portal.  A copy of the Service Agreement is to be uploaded into the Portal prior to making a claim.

  17. Please inform the Pharmacy Programs Administrator as soon as the Service Agreement is terminated. This can be done by sending an email to support@ppaonline.com.au or contacting the Pharmacy Programs Administrator Support Centre.  Failure to provide this information may result in recovery of payments made to you.

  18. Claims are due at the end of the next calendar month after the service was completed, e.g. for a service completed on 15 February, claims should be submitted by 31 March.  Claims submitted after this date will not be paid.

  19. This is up to you: as long as the claim is submitted by the end of next month following the date of service, you can submit as many claims as you like.

  20. No, if you miss the timeframe you will not be eligible to make a claim. 

  21. Each Patient is allowed to have a RMMR Service once every 24 months. A subsequent RMMR Service may only be conducted if more than 24 months has elapsed since the date of the most recent Patient Interview, or when the Patient’s General Practitioner specifically deems a subsequent review is clinically necessary, e.g. such as when there has been significant change to the Patient’s condition or medication regimen.  Please note, provision of a subsequent RMMR must not be triggered solely by an ‘anniversary’ date as the service is not intended to be part of an ongoing review cycle.

  22. Yes, if you make repeated attempts and are unable to contact the GP, you can apply for prior approval for a Program Variation to conduct a Pharmacist Only Review. Applications are made via the Pharmacy Programs Administrator Portal. Please note that applications for approval must be made at least 10 working days prior to the proposed date of the Patient Interview.  Retrospective approval will not be granted. The RMMR Service Provider must provide information that outlines a detailed and reasonable justification for a service to be conducted without a GP’s involvement.  The Applications will be assessed by the Department of Health on the evidence provided.  If approval is granted you will not be asked to provided GP referral and report dates when submitting the claim.

  23. You have 90 days to complete the RMMR Service; however, if you are unable to perform the service within 14 days of receiving the referral you should contact the GP and discuss when the service will happen.

  24. 30 days from the date of service.

  25. The Residential Medication Management Review Program Rules are available from the Downloads section of this page.

    If you have further queries, you can also contact the Pharmacy Programs Administrator on 1800 951 285 or support@ppaonline.com.au.

Quality Use of Medicines FAQ

  1. To be eligible to become a QUM Service Provider you must be:

    ·       An owner of an approved Section 90 Community Pharmacy

    ·       A business entity with an Australian Business Number (ABN). This includes an Accredited Pharmacist operating as a sole trader.

    Service Providers who are not eligible are:

    • Any organisation that is able to initiate a referral for the RMMR Service
    • A Section 94 Pharmacy
    • A public or private hospital.

    A QUM Service Provider must have executed a QUM Service Agreement with an eligible Aged Care Facility.  The RMMR Service must be delivered by an Accredited Pharmacist.

  2. Facilities that qualify for the QUM Program are Australian government funded. This includes:

    • Aged Care Facilities that receive the residential care subsidy in accordance with the Aged Care Act 1997
    • Transition care facilities
    • Multi-purpose service facilities.
  3. No, Facilities that qualify for the QUM Program are Australian government funded. This includes:

    • Aged Care Facilities that receive the residential care subsidy in accordance with the Aged Care Act 1997
    • Transition care facilities
    • Multi-purpose service facilities.

    Wholly privately-owned facilities are not eligible for the Program. 

  4. The service must be performed by any Accredited Pharmacist or Registered Pharmacist employed or contracted by the Service Provider.

  5. Yes; however, you must have an ABN to be registered for the Program. Accredited Pharmacists or Registered Pharmacists can provide QUM Services. Remember, though, that there must be a QUM Service Agreement in place between yourself and the Facility before completing any QUM Services.

  6. Yes, each Facility must only have one contracted QUM Service Provider. You will not be able to submit a claim for QUM without first providing an executed Service Agreement (contract) between your Service Provider and the Aged Care Facility.

  7. Yes; however, each Facility must only have one contracted QUM Service Provider and one contracted RMMR Service Provider.

  8. A copy of the QUM Service Agreement template is available from the Downloads section of this page

     

  9. Yes, the QUM Service Agreement template is available from the Downloads section of this page.

  10. Yes, the Pharmacy Programs Administrator can inform you if a Facility has a contracted Service Provider; however, for privacy reasons, we are unable to tell you who the Service Provider is.

  11. Existing contracts in place with Aged Care Facilities that were established and approved by the Pharmacy Guild prior to 1 February 2019, and have an end date on or after 1 February 2019, will continue to apply. Existing Service Providers will not need to create new Service Agreements with Aged Care Facilities until current Agreements expire. Service Providers establishing new Service Agreements can access the Service Agreement example available from the Downloads section of this page.

  12. No, existing contracts in place with Aged Care Facilities that were established and approved by the Pharmacy Guild prior to 1 February 2019, and have an end date on or after 1 February 2019, will continue to apply.  Existing Service Providers will not need to create new Service Agreements with Aged Care Facilities until their current Agreements expire. Service Providers establishing new Service Agreements can access the Service Agreement example template, available from the Downloads section of this page.

  13. Yes: if you have extended an existing QUM Service Agreement with an Aged Care Facility and need this reflected in the Portal, please email the Support Centre at support@ppaonline.com.au. In your email, please specify the Aged Care Facility name, the new Service Agreement end-date and attach evidence of the extension.

    Please confirm new extension arrangements prior to the end of your current agreement and before you make a claim against the new contract period.

  14. You must log in and register as a Service Provider if you have not already registered, and then register the Facility in the Pharmacy Programs Administrator Portal.  A copy of the Service Agreement is to be uploaded into the Portal.

  15. Please inform the Pharmacy Programs Administrator as soon as the Service Agreement is terminated. This can be done by sending an email to support@ppaonline.com.au or contacting the Pharmacy Programs Administrator Support Centre.  Failure to provide this information may result in recovery of payments made to you.

  16. Claims for QUM services provided to an eligible Aged Care Facility must be claimed by the end of the month following the quarterly service period.  For example,  if the Service Agreement commences on 1 January, then the quarterly service period will be from 1 January to 31 March.  The claiming window will open at the end of the quarter and will close at the end of the following month (e.g. a period that ends in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

  17. At least one activity a quarter must be provided to claim a QUM payment from the list of QUM activities listed in the QUM Program Rules; however, more than one activity is allowed and encouraged to be completed.

  18. Yes, if the final period of your Aged Care Facility Service Agreement is not three whole months and you are not extending your Service Agreement, please contact the Support Centre on 1800 951 285 to arrange a pro-rata payment based on the number of days left in the contract. The claim is still due within 30 days of the end of the claiming period.

  19. If there is no break in the timing of the Service Agreement, i.e. if the new Service Agreement begins on the day after the previous Service Agreement ends, then you can submit one claim for the three-month period.  If there is a break between Service Agreements, then you will need to submit two claims. If you have extended an existing QUM Service Agreement with an Aged Care Facility and need this reflected in the Portal, please email the Support Centre at support@ppaonline.com.au.  In your email, please specify the Aged Care Facility name, the new Service Agreement end-date and attach evidence of the extension. Please also confirm new extension arrangements prior to the end of your current agreement and before you make a claim against the new contract period.

  20. No, claims should be sequential. If you miss a three-month period then unfortunately those three months are missed.

  21. The Quality Use of Medicines Program Rules are available from the Downloads section of this page.

    If you have further queries, you can also contact the Pharmacy Programs Administrator on 1800 951 285 or support@ppaonline.com.au.