Program Integrity & Compliance State PBM Reforms: Key Medicaid and Pharmacy Benefit Changes to Watch Legislative movements in numerous states signed into law introduce significant reforms to pharmacy benefit manager (PBM) practices within affected states. These statute changes are designed to enhance transparency and redefine pharmacy reimbursement models, marking a shift in how PBMs must…
Medicaid Policy & Strategy Improving Pharmacy Benefit Oversight in the Era of Medicaid Managed Care Explore effective approaches to improve pharmacy benefit management, enhance transparency, and streamline oversight in Medicaid managed care with innovative solutions tailored to state-specific needs. Key Takeaways When managed care organizations contract with pharmacy benefit managers, a layer of complexity and…
Behavioral Health Certified Community Behavioral Health Services A complex model of care demanding thorough planning and strategic execution in response to the growing need for integrated and innovative behavioral health care solutions. Key Takeaways The Certified Community Behavioral Health Clinic (CCBHC) model is transforming behavioral health care by delivering integrated, person-centered solutions to address diverse…
Medicaid Policy & Strategy Understanding Intellectual and Developmental Disabilities Recognizing the role of Medicaid and advocacy during Developmental Disability Awareness Month. Key Takeaways Developmental Disability Awareness Month, observed each March, highlights the importance of recognizing and supporting individuals with intellectual and developmental disabilities (IDDs) by fostering community engagement, advocacy, and collaboration. Myers and Stauffer work…
Health care delivery & transformation CMS Releases Innovation in Behavioral Health (IBH) Model The Centers for Medicare & Medicaid Services (CMS), through the Center for Medicare and Medicaid Innovation (CMMI), has released the Notice of Funding Opportunity (NOFO) for Cohort II of the Innovation in Behavioral Health (IBH) Model. Key Takeaways The Centers for Medicare…
Health Care Delivery & transformation Maximizing RHTP Awards: A Strategic Roadmap for Sustainable Rural Health Systems Rural health systems are under sustained pressure as many communities confront shrinking provider capacity, unstable hospital finances, limited access to specialty and maternal care, workforce constraints, and the added strain of distance and aging infrastructure alongside rising demand. Key…
Public Health & Community Impact Cancer Awareness Month: Empowering Through Knowledge and Support October marks Cancer Awareness Month, a pivotal time to raise awareness about the challenges and disparities surrounding cancer care while empowering individuals with essential knowledge and support. Key Takeaways As we honor those affected by all forms of cancer, it’s vital to…
House of Representatives Bill H.R. 1, An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 Sec. 71115 Provider Taxes Sec. 71116 State Directed Payments Sec. 71117 Requirements Regarding Waiver of Uniform Tax Requirement Sec. 71119 Requirement for States to Establish Medicaid Community-Engagement Requirements for Certain Individuals Sec. 71401 Rural…
Client Alert: House of Representatives Bill H.R. 1, Sec. 71119 Requirement for States to Establish Medicaid Community-Engagement Requirements for Certain Individuals Medicaid Disproportionate Share Hospital (DSH) January 2019 Sec. 71119 Requirement for States to Establish Medicaid Community-Engagement Requirements for Certain Individuals Signed into law July 4th, 2025 Enrolled Bill Bill Overview On July 4, 2025,…
Client Alert: House of Representatives Bill H.R. 1, An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 Medicaid Disproportionate Share Hospital (DSH) January 2019 Sec. 71401 Rural Health Transformation Program Signed into law July 4th, 2025 Enrolled Bill Bill Overview On July 4, 2025, the President signed the House…
Behavioral health | public health & Community impact National Drug and Alcohol Facts Week The scope of substance use disorders in America and what is being done. Key Takeaways During National Drug and Alcohol Facts Week® (NDAFW), the National Institute on Drug Abuse shines a spotlight on substance use disorders (SUDs) and addiction, raising awareness…