syrtis solutions Archives - Page 11 of 17

11 Sep CONCERNS OVER CA’s Rx CARVE OUT

Posted at 14:24h in Medicaid

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...

29 Aug MEDICAID IMPROPER PAYMENTS IN FY 2018

Posted at 08:44h in Coordination of Benefits, Medicaid

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...

20 Aug DHCS SEEKS FFS Rx BENEFIT MANAGEMENT

Posted at 13:52h in Medicaid, Medicaid Managed Care

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...

30 Jul COST AVOIDANCE TECHNOLOGY SOLUTIONS FOR MEDICAID

Posted at 13:51h in 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...

23 Jul MEDICAID COSTS PUT EMPHASIS ON RECOVERY EFFORTS

Posted at 09:38h in Medicaid

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,...

28 Jun CMS AUDITS OVER MEDICAID IMPROPER PAYMENTS

Posted at 11:13h in Medicaid

Recent reports from the HHS OIG and the Louisiana Auditor General have indicated a high rate of Medicaid improper payments due to incorrectly determining Medicaid eligibility. The Senate Finance Committee wrote CMS on March 1st to inform the agency of their concerns over the...

27 May LEGISLATION FAILS TO REDUCE IMPROPER PAYMENTS IN GOVERNMENT-FUNDED PROGRAMS

Posted at 11:36h in Medicaid

Legislation such as the Improper Payments Information Act (IPIA P.L. 107-300) and Executive Order 13520 sought to address improper payments in government-funded programs. IPIA directed federal agencies to report on the number of improper payments occurring and outline what actions are being taken to reduce...

17 May HB 3388 SEES SIGNIFICANT CHANGES

Posted at 10:42h in Medicaid

2019 has been a busy year for healthcare legislation in Texas and one bill, in particular, aimed to carve out PBM’s entirely. House Representative J.D. Sheffield (R) introduced HB 3388 on March 6th in an attempt to reform the delivery of prescription drugs to a...

17 Apr THE IMPACT OF MEDI-CAL’S PHARMACY CARVE OUT

Posted at 13:57h in Medicaid

At the beginning of the year, California’s governor signed an executive order directing DHCS to adopt a fee-for-service model for Medi-Cal. Under the order, California would consolidate its purchasing power and leverage the state’s population size to achieve lower drug costs by purchasing in...

10 Apr REDUCING MEDICAID’S PRESCRIPTION DRUG COSTS

Posted at 14:15h in Medicaid

Since state Medicaid programs are responsible for the healthcare of several populations, skyrocketing prescription drug costs have become a major budgetary concern. Currently, health care spending is dominating many of their budgets and on a per capita basis, inflation-adjusted retail prescription drug spending has increased...

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