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As per federal regulations, a beneficiary must meet all of what criteria in order to qualify for MTM services?

User Gabidavila
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Final answer:

To qualify for federal MTM services, beneficiaries must meet criteria that usually include having specific chronic conditions, taking multiple Part D medications, and having high prescription costs.

Step-by-step explanation:

The federal regulations stipulate specific criteria for individuals to qualify for Medication Therapy Management (MTM) services. In general, MTM services are designed to optimize therapeutic outcomes for patients through improved medication use and to reduce the risk of adverse events. While federal requirements cover the provision of MTM services for certain populations such as the blind, the disabled, and children under the Children's Health Insurance Program (CHIP), they primarily apply to Medicare beneficiaries meeting eligibility criteria such as having multiple chronic diseases, taking multiple Medicare Part D drugs, and likely having medication costs above a certain threshold.

Each state has the autonomy to set additional eligibility criteria for their Medicaid program which can differ considerably across states. As such, a person eligible for Medicaid in one state may not be eligible in another. It's also worth noting that Medicaid contributes significantly to the funding of long-term care in the United States, covering about two-thirds of the cost of nursing home care nationally.

User Matt Boehm
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