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Compliance Insights February 2014

This issue of Compliance Insights focuses on the proposed CY 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs. Proposed changes include:

  • Plans No Longer Allowed to Require FDRs to Do Additional Training Beyond CMS Standardized Training
  • Plans May Be Required to Hire Independent Auditor for CMS Program Audits
  • New Timeframe Requirements for Pharmacy Mail Order Services
  • Potential Decrease in Number of Chronic Diseases, Medications and Cost Threshold for MTM eligibility (MTM) Under Part D
  • Experience Requirements Proposed for First Time Part D Applicants or Their Contracted FDRs
  • Clarification of Permitted Extensions of Adjudication Timeframes for Organization Determinations and Reconsiderations

To read more, click here.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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