As more patients age in place or receive skilled-level support in non-institutional settings, pharmacies are increasingly called upon to deliver high-touch, coordinated services outside of traditional long-term care facilities. However, despite the clinical complexity and regulatory sensitivity of these services, the LTC at Home sector has historically lacked standardized compliance guidelines.

This manual exists to fill that gap. It outlines a clear, actionable framework that pharmacies can follow to ensure services meet federal, state, payer, and CMS-level requirements for institutional care, regardless of where the patient resides. Whether you are new to LTC at Home or expanding existing services, this manual provides the structure, tools, and clinical expectations to support compliant and sustainable care delivery.

The manual directly supports and aligns with the Long Term Care at Home Pharmacy Accreditation Program, helping pharmacies prepare for accreditation or maintain their good standing post-accreditation. Every standard detailed in this guide corresponds to minimum care expectations validated by plans, payers, accrediting bodies, and pharmacy experts. Key accreditation-linked areas include:

• Patient qualification criteria based on CMS-aligned clinical indicators
• Required documentation to support billing and care audits
• Minimum service expectations for medication management, care coordination, and ongoing monitoring
• Minimum service expectations for medication management, care coordination, and ongoing monitoring

Pharmacies undergoing accreditation are evaluated against the standards outlined in this manual. It provides a blueprint not only for earning accreditation but for sustaining excellence in clinical service delivery and contractual compliance.

This manual is intended for:

• Pharmacies actively providing or preparing to provide LTC Pharmacy at Home services
• Pharmacists and technicians responsible for patient onboarding, documentation, or care delivery
• Pharmacy administrators and compliance officers overseeing service implementation and credentialing
• PBMs, Health Plans, PSAOs, GPOs, seeking to:
  • Implement compliant LTC Pharmacy at Home services into their ecosystem
  • Understand or verify a pharmacy’s ability to support LTC at Home patients

It is suitable for both closed-door LTC pharmacies and dual-NPI combo pharmacies, and includes detailed guidance on organizational structure, setup readiness, and billing requirements to support all pharmacy types.

This manual includes:

• Detailed patient qualification criteria based on waiver enrollment, recent discharge from skilled care, chronic disease burden, functional impairment, and mobility limitations
• A standardized Patient Qualification Form with a 6-month reassessment schedule
• Medication Dispensing Review (MDR) template and implementation guide to support safe, proactive medication management
• Guidance on billing and coding, including use of LTC NPI and PRC 01 claims routing
• Organizational structure requirements for LTC pharmacy setup (e.g., dual-NPI setup, GPO enrollment, PSAO contracting)
• Care coordination and provider communication guides to support collaborative care and clinical integration
• Medication synchronization standards that include compliance packaging alignment and ancillary medication coordination
• Limited mobility assessment guide and checklist to help document a patient’s eligibility status accurately
• Waiver identification tools and resources, including a 50-state Medicaid waiver directory and program search guidance
• A readiness checklist to ensure pharmacies are operationally prepared to support LTC at Home before billing begins

The manual is available:

• For download here as a PDF with embedded links and template access
• In printed form for reference use, available for purchase in late 2025 or as part of accreditation preparation packages

Pharmacies are encouraged to use the manual not only as a one-time tool but as a living reference document—updated regularly to reflect CMS, state, and payer-level changes. The Commission issues a version accordingly when new guidance, tools, or language changes occur.

Patients who receive skilled-level care at home deserve the same level of pharmacy service as those in traditional LTC facilities. That means compliance is not optional—it is essential. This manual ensures pharmacies have the knowledge, tools, and clarity to deliver that care safely, compliantly, and consistently.

As the industry moves toward increased payer oversight and regulatory scrutiny in the LTC at Home space, pharmacies must take steps now to protect their operations and prove their value. This manual is how you do that—with structure, confidence, and care.