Consortium for Medicare Health Plans Operations

Nancy O'Connor, Acting Consortium Administrator, 215-861-4140
Raymond Hurd, Deputy Consortium Administrator, 617-565-1188

Raymond Hurd, Regional Administrator for New York and Boston, 617-565-1188
Nancy O'Connor, Regional Administrator for Philadelphia, 215-861-4140
Michelle Baker-Bartlett, Acting Deputy Regional Administrator for Boston, 212-616-2205
Michelle Baker-Bartlett, Deputy Regional Administrator for New York, 212-616-2205
Sharon Graham, Deputy Regional Administrator for Philadelphia, 215-861-4304

Douglas Edwards, Associate Regional Administrator, Boston Division of MHPO, 617-565-1321
Heather Lang, Associate Regional Administrator, New York Division of MHPO, 212-616-2300
Mariana Diaz, Puerto Rico Field Office Director, 787-294-1681
Tamara McCloy, Associate Regional Administrator, Philadelphia Division of MHPO, 215-861-4220
Mortez Williams, Associate Regional Administrator, Atlanta Division of MHPO, 404-562-7361
Raymond Swisher, Associate Regional Administrator, Chicago Division of MHPO, 312-886-5354
Arthur Pagan, Associate Regional Administrator, Dallas Division of MHPO, 214-767-6420
Judith Flynn, Associate Regional Administrator, Kansas Division of MHPO, 816-426-6534
Laura Coleman, Associate Regional Administrator, Denver Division of MHPO, 303-844-2126
Ann Duarte, Associate Regional Administrator, San Francisco Division of MHPO, 415-744-3770
Brenda Suiter, Associate Regional Administrator, Seattle Division of MHPO, 206-615-2371

Functional Statement

  • Serves as the Field focal point for all interactions with managed health care organizations, Medicare Advantage Plans, Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug (Part D) plans for issues relating to CMS programs, policy and operations.
  • Serves as the Field’s focal point for all CMS interactions with employers, employees, retirees and others operating on their behalf pertaining to issues related to CMS policies and operations concerning employer sponsored prescription drug coverage for their retirees.
  • Serves as the Field focal point for all interactions with beneficiaries, their families, care givers, health care providers, and others operating on their behalf concerning improving beneficiary’s ability to make informed decisions about their health and about program benefits administered by CMS.  These activities include strategic and implementation planning, execution, assessment and communications.
  • Implements national policy for Medicare Parts C and D beneficiary eligibility; enrollment; entitlement; premium billing and collection; coordination of benefits; rights and protections; dispute resolution process; as well as policy for managed care enrollment and disenrollment to assure the effective administration of the Medicare program.
  • Participates in the development of national policies and procedures related to the development, qualification and compliance of health maintenance organizations, competitive medical plans and other health care delivery systems and purchasing arrangements (such as prospective pay, case management, differential payment, selective contracting, etc.) necessary to assure the effective administration of CMS' programs, including the development of statutory proposals.
  •  In conjunction with the Center for Medicare (CM) handles all phases of contracts with managed health care organizations eligible to provide care to Medicare beneficiaries.
  • Responds to inquiries regarding Parts C and D coverage and payment policies.
  • Implements national policies and procedures to support and assure appropriate State implementation of the rules and processes governing group and individual health insurance markets and the sale of health insurance policies that supplement Medicare coverage.
  • In conjunction with CM, implements regulations, guidelines, and instructions required for the dissemination of appeals policies to Medicare beneficiaries, Medicare Advantage (MA) plans, Prescription Drug Plans (PDPs), CMS regional offices, beneficiary advocacy groups and others interested parties.
  • Assures, in coordination with other Consortium Administrators, Central Office Centers and Offices, and the Chief Operating Officer (COO), the activities of Medicare managed care plans, agents, and State Agencies meet CMS' requirements on matters concerning beneficiaries and other consumers.
  • In partnership with appropriate Central Office Offices and COO, administers the contracts and grants related to beneficiary and customer service, including the State Health Insurance Assistance Program grants.
  • Participates in the formulation of strategies to advance overall beneficiary communications goals and coordinates the Field implementation of all beneficiary-centered information, education, and service initiatives.
  • Builds a range of partnerships with other national organizations for effective consumer outreach, awareness, and education efforts in support of CMS programs.
  • Serves as the Consortium focal point for emergency preparedness for the field.
  • Provides oversight in the areas of human resource procurement and logistics.
  • Ensures the effective management of CMS’ information technology, and information systems and resources in the field.
  • Implements the privacy and confidentiality policies pertaining to the collection, use, and release of individually identifiable data.
  • Proactively establishes, manages, and fosters partnerships within the region with State and local governments, providers and provider associations, beneficiaries and their representatives, and the media that are focused on CMS’ goals and objectives.
  • Serves as the primary point of contact to appropriate members of Congress, State Governors, Federal, State, and local officials and tribal governments on matters concerning the Medicare and Medicaid programs.
  • Oversees the coordination and integration of CMS activities with other Federal, State, local, and private health care agencies and organizations.
  • Counsels, advises, and collaborates with top CMS officials on policy matters and major considerations in developing, implementing, and coordinating CMS’ programs as they interrelate in addressing national and regional strategies.
  • Advises the Office of the Administrator on special programs as they relate to national initiatives and as they impact major constituents or their key representatives.
  • Promotes accountability, communication, coordination and facilitation of cooperative corporate decision-making among CMS top senior staff on management, operational and programmatic issues cross-cutting organizational components with diverse functions and activities.
Page Last Modified:
10/02/2019 07:31 AM