Manual of Compliance and Care Expectations for Pharmacies Engaging in Long Term Care Pharmacy at Home Services and Supports
Patient Qualification Form
Medication Dispensing Review (MDR) Template
Medication Dispensing Review Implementation Guide
Patient Qualification Implementation Guide
Pharmacy LTC at Home Setup Readiness Checklist
Care Coordination Guide
Provider Communication Guide
Skilled Nursing Facility and Unit Identification Guide
Limited Mobility Assessment Guide
Limited Mobility Assessment Checklist
How to Identify Patient Waiver or Participating Programs That May Qualify Patients
Where to Find Waiver Programs and Qualifying Services
Billing & Coding Guide
Copyright Notice & Disclaimer
© 2025 Long Term Care at Home Pharmacy Quality Commission. All Rights Reserved. All templates, guides, and reference materials provided on this page are the intellectual property of the Long Term Care at Home Pharmacy Quality Commission and are protected under applicable copyright laws. These resources are made available solely for use by pharmacies, providers, and industry stakeholders engaging in Long Term Care Pharmacy at Home services. No portion of these materials may be reproduced, altered, distributed, or used for commercial purposes without the prior written permission of the Commission.
Disclaimer: The materials provided on this page—including the Manual of Compliance and Care Expectations, Patient Qualification Form, MDR tools, implementation guides, checklists, and billing guides—are intended as general resources to support compliant service delivery. These documents do not replace legal advice, payer-specific requirements, or state and federal regulations. The Commission makes no express or implied representations or warranties regarding the completeness, accuracy, or applicability of the included materials for any specific pharmacy or use case. Pharmacies and users of these materials remain solely responsible for ensuring their practices meet the requirements of their contracts, licensing entities, and regulatory agencies. The Commission disclaims any liability for reliance on or misuse of these resources.
- NIH ADL/IADL Reference https://www.ncbi.nlm.nih.gov/books/NBK470404/
- CMS Chronic Conditions Data Warehouse https://www2.ccwdata.org/web/guest/home
- CMS Chronic Condition Special Needs Plan (C-SNP) Chronic Disease List https://www.cms.gov/medicare/health-plans/specialneedsplans/c-snps
- CMS Guidance on Part D Dispensing Fees and Enrollees with Institutionalized Level of Care Needs MEMO (2021) https://ncpa.org/sites/default/files/2021-12/partddispfeeinstlevelcareneed.pdf
- CMS Long Term Care Standards Guidance (2005) https://www.ltcathomequalitycommission.com/wp-content/themes/longtermay533/pdf/CMS-LTC-STANDARDS-GUIDANCE-2005.pdf
- The Lewin Group CMS Review of Current Standards of Practice for Long-Term Care Pharmacy Services (2004) https://www.ltcathomequalitycommission.com/wp-content/themes/longtermay533/pdf/CMS-December-2021-Guidance.pdf
Copyright Notice & Disclaimer for Reference Section
© 2025 Long Term Care at Home Pharmacy Quality Commission. All Rights Reserved. The Reference Section contains publicly available links to external government, regulatory, and industry websites for informational use only. These resources are curated to support pharmacies, providers, and stakeholders seeking additional guidance on topics related to Long Term Care Pharmacy at Home services. No ownership is claimed over external websites or their content, and all trademarks and content remain the property of their respective organizations.
Disclaimer: The Long Term Care at Home Pharmacy Quality Commission does not control, endorse, or guarantee the accuracy, relevance, timeliness, or completeness of the content found on external websites linked in this section. These references are provided solely for convenience and educational purposes. Users are responsible for reviewing and complying with the terms, conditions, and updates of those external sources. The Commission assumes no responsibility or liability for any errors, omissions, or outcomes resulting from the use of the information found through these links.