Medicaid

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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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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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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Rx Carve Out Syrtis Solutions Medicaid California

11 Sep CONCERNS OVER CA’s Rx CARVE OUT

California’s Governor, Gavin Newsom, signed an executive order at the beginning of the year to move all pharmacy services for Medi-Cal from managed care to a FFS model. The consolidated purchasing power would leverage the state’s population size to negotiate drug prices with pharmaceutical...

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Medicaid Improper Payments Syrtis Solutions DHHS

29 Aug MEDICAID IMPROPER PAYMENTS IN FY 2018

DHHS has released its annual Agency Financial Report for FY 2018. The report provides an overview of improper payments in the Medicaid program, root causes for the payments, and corrective actions. In line with the agency's goal of reforming, strengthening, and modernizing the nation’s healthcare...

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DHCS FFS Syrtis Solutions Prescription Drug Costs Medicaid

20 Aug DHCS SEEKS FFS Rx BENEFIT MANAGEMENT

In January, California’s newly elected Governor, Governor Gavin Newsom signed an executive order to drastically reform health care in the state. Executive Order N-01-19 introduced a number of actions and budget proposals to reduce the cost of prescription drugs and health care. One measure, in...

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Medicaid Managed Care Saves Plans Money

30 Jul COST AVOIDANCE TECHNOLOGY SOLUTIONS FOR MEDICAID

In addition to rising health care costs and increased spending from the program’s expansion, Medicaid is losing billions of dollars a year from improper payments. Protecting the integrity of the Medicaid program has become a top priority for the Centers for Medicare and Medicaid Services...

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Medicaid cost avoidance

23 Jul MEDICAID COSTS PUT EMPHASIS ON RECOVERY EFFORTS

In 1965, Title XIX of the Social Security Act established the Medicaid program to provide health care coverage to low-income individuals. Over time it has developed into one of the nation's largest payers for health care, covering one out of five Americans. In FY 2017,...

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