Medicaid MTM Standards published by the National MTM Advisory Board

2022-11-01 20:57:01



Why Medication Therapy Management is important  and why should you adopt an MTM program
In general, evidence consistently demonstrates that MTM is a clinically and financially effective intervention for Medicaid enrollees and other insured individuals. To create an effective MTM program it is important to understand the applicable governing bodies (including the State Medicaid Agency, State DUR Board and State Board of Pharmacy) that will impact the design of MTM program standards. It is recommended that State Medicaid Agencies and MCOs work in collaboration when defining the requirements of the MTM program to ensure optimal patient care and program outcomes. The recommendations included in the below document should be taken as minimum standards. We encourage states and MCOs to go beyond these standards to meet the needs of their state’s Medicaid enrollees.

Why Standards are Beneficial

Standards allow for optimization and efficiency. In today’s Medicaid environment each state is afforded the ability to craft MTM program guidance individually. Inconsistent program designs have then resulted in organizations expending outsized efforts to meet these designs within each state where they may operate. Although the customizable nature of the current way of operating has allowed states free reign in their design of programs, an opportunity exists to promote general standardization. The goal of this standardization would be to improve efficiency along with tracking and impacting patient outcomes from MTM service provision. To maintain a program of high quality it is recommended that the State Medicaid Agency create or leverage existing committees of partners across the state that would engage with the MTM Program. This committee would be tasked with evaluation and enhancement of the program to ensure the program remains true to its core objective and continues to evolve and meet the needs of the state’s Medicaid enrollees. Examples of Committee members could include:
  • Beneficiaries or Caregivers of Beneficiaries (Including Tribal Representatives)
  • State Medicaid Agency representatives
  • State Board of Pharmacy representatives
  • State Medical Board representatives 
To review the standards recommended and published by the National Medication Therapy Management Advisory Board click below. 
View the Medicaid MTM Standards
Visit the National MTM Advisory Board website to learn more about how the board is guiding the future of Medication Therapy Management through shared expertise and collaboration.