TennCare launches Medication Therapy Management Pilot Program

January 10, 2018

TennCare launched the Medication Therapy Management (MTM) pilot program as part of its payment reform initiative. The MTM pilot program is a voluntary program that further incorporates the pharmacist into team-based care provided to eligible members in Patient Centered Medical Home (PCMH) and Health Link (HL). The primary goals of MTM services is to work with eligible members to actively manage their drug therapy by identifying, preventing, and resolving medication related problems helping to reduce emergency department and inpatient visits. There are few key items the PCMH or HL organization and pharmacist must complete in order to participate in the MTM pilot: 

  • The pharmacists must acquire their own TennCare Medicaid ID (pharmacist may not use the pharmacy’s Tax ID).

  • There must be a formal collaborative practice agreement (CPA) in place between the PCMH/THL physician and the pharmacist.

  • Pharmacist must engage and complete the MCO credentialing and network agreements.

  • After a CPA is in place, the pharmacist may initiate the process of Care Coordination Tool (CCT) registration, training and access by emailing TennCare.Pharmacy.AdobeSign@tn.gov

The pharmacist participating in the MTM pilot will be paid a case rate based on the medication therapy management codes specific to pharmacists. The reimbursement case rates range from $15 to $25 and have payment limits based on the service description.  The MTM reimbursement is separate from the PCMH and HL reimbursement.

For more information please refer to the website at https://www.tn.gov/tenncare/providers/pharmacy/medication-therapy-management-pilot-program.html. For questions email TennCare.MTMpilot@tn.gov.