FAQ — LTC@H Pharmacy Comprehensive Q&A

All LTC@H network members

Q: What is LTC at Home pharmacy?

LTC at Home is a pharmacy service model in which a community pharmacy provides long-term care level pharmaceutical services — clinical oversight, compliance packaging, care coordination, and comprehensive documentation — to patients who live in home or community-based settings rather than institutional facilities.

Q: Who qualifies as an LTC@H patient?

Patients must meet at least one qualifying criterion: a complex medication regimen (typically 5 or more chronic medications), a functional limitation affecting self-administration, enrollment in a qualifying Medicaid HCBS waiver program, or documented post-acute care needs. A completed qualification form and pharmacist attestation must be on file before billing LTC@H rates.

Q: How is LTC@H different from standard retail pharmacy?

LTC@H adds three services Unique to LTC@H: (1) Dispensing Medication Review — a pharmacist-level clinical review at each fill cycle; (2) Care Coordination with Transition of Care Management — proactive management of care transitions; and (3) Comprehensive Patient Care Documentation — structured monthly medication reviews and a complete patient playbook.

Q: Can I do LTC@H if I also run a retail pharmacy?

Yes — most LTC@H pharmacies operate both retail and LTC@H service lines. The key is workflow separation: different fill cycles, documentation processes, and clear staff role definition between the two service lines.

Q: How long does credentialing take?

Credentialing typically takes 60 to 120 days from application to approval. Plan your patient enrollment timeline accordingly — do not enroll patients before credentialing is approved.

Q: What documentation must be in place before my first LTC@H claim?

Three documents must be dated before the first claim date: the completed patient qualification form, the signed pharmacist attestation, and the medication acquisition form. The full patient playbook should also be complete at or before the first fill.

Q: How often must I conduct a drug regimen review?

Monthly, for each active LTC@H patient. Verify your specific contract language with your PSAO — monthly is the standard requirement but your agreement may specify additional details.

Q: What is the patient playbook?

The three-component intake package: (1) the Physician Notification document sent to the prescriber; (2) the completed Medication Reconciliation; and (3) the Five-Star Questionnaire assessing applicable Star Ratings measures. All three must be completed at patient admission.

Q: What happens if my LTC@H patient is hospitalized?

A hospitalization triggers a care coordination event under S10. Request the discharge medication list, reconcile it against your dispensing record, communicate changes to the prescriber, and update the medication reconciliation. See the Care Coordination and Discharge Medications articles.

Q: How do I grow my LTC@H patient panel?

Primary referral sources: home health agencies, hospital discharge planners, primary care physicians with elderly panels, and Medicaid waiver case managers. Building relationships through clinical credibility and reliable service is the most effective growth strategy.