Blog

CMS Section 1135 Waivers Medicaid Syrtis Solutions

30 Mar SECTION 1135 WAIVERS AID STATES AMID COVID-19

After COVID-19 was declared a national emergency on March 13th, the Centers for Medicare and Medicaid Services (CMS) was able to waive stipulations in federally funded programs to help States respond to the pandemic. To date, CMS has approved Medicaid Section 1135 Waivers for 23...

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Michigan Medicaid Rx Carve Out Preferred Drug List Syrtis Solutions

11 Mar MICHIGAN MOVES AWAY FROM RX CARVE-OUT

From Carve-Out to Single PDL Back in September, Michigan proposed policy 1936-Pharmacy to carve-out the State’s Managed Medicaid outpatient pharmacy drug coverage and transition to a Fee-for-Service (FFS) model. However, plans to carve-out pharmacy benefits have recently been updated. After considering the policy, the State has...

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Monthly Medicaid News Recap Syrtis Solutions

09 Mar FEBRUARY MEDICAID NEWS RECAP

Syrtis Solution's February 2020 Medicaid News Recap: A roundup of Medicaid news, legislation, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse. Minnesota's Medicaid program made up to $29 million in improper payments for duplicate accounts   StarTribune, February 25The state agency...

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Medicaid Prescription Drug Cost Managed Care Syrtis Solutions

27 Jan MEDICAID MANAGED CARE Rx BENEFITS HELP STATES

Medicaid prescription drug spending has been on the rise and some states have opted to carve out prescription drug benefits and transition to a Fee-For-Service (FFS) model. In theory, this delivery system helps states assert their purchasing power to reduce costs and improve oversight. However,...

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DISCORD AT HHS VERMA AZAR

16 Dec DISCORD AT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

Government healthcare reforms along with reducing prescription drug prices have been at the top of President Donald Trump’s agenda. A feud between the top health officials at HHS is delaying the administration’s healthcare initiatives. Over the past year, tensions have been building between HHS Secretary Alex...

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Michigan Rx Carve Out Syrtis Solutions Medicaid

25 Nov MICHIGAN MEDICAID PBM RX CARVE OUT

To reduce costs in its Medicaid Health Plan (MHP), Michigan is carving out pharmacy benefit managers (PBMs) and transitioning to a fee for service (FFS) model for the delivery of prescription drugs. In October, Michigan’s Department of Health and Human Services (MDHHS) announced that outpatient...

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Medicaid Third Party Liability GAO CMS Syrtis Solutions ProTPL TPL OHI

20 Sep Medicaid Third Party Liability Report From GAO

Identifying third party liability continues to be a challenge under the coordination of benefits for Medicaid plans. By law, plans are payers of last resort so whenever beneficiaries have other active coverage (OHI), those third parties should pay first. Currently, Medicaid plans are required to...

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