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As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS is replacing its current claims payment contractors - fiscal intermediaries and carriers - with new contract entities called Medicare Administrative Contractors (MACs). CMS plans to award a total of 19 MAC contracts through three procurement cycles. Fifteen of these contracts will be with entities that will cover the majority of Part A and Part B services, i.e., A/B MACs. Proposed Rule Regarding Assignment of Providers and Suppliers to MACs On November 24, 2006, CMS issued the final rule that would implement certain related provisions of the Medicare Modernization Act, including a portion of the Medicare Contracting Reform provision from section 911, as well as revise the Medicare hospital outpatient prospective payment system. A portion of the rule deals with the agency's plans to revise parts of the current regulatory language concerning Medicare intermediary and carrier contracting authorities with ones pertinent to the new Medicare Administrative Contractors (MACs). The rule entitled "Medicare Program-Revisions to Hospital Outpatient Prospective Payment System and Calendar Year 2007 Payment Rates" is 443 pages in length. The language pertinent to the changes associated with Medicare Contracting Reform is contained in about 9 pages (223-231) of the regulation. Included in the rule is language explaining that MMA section 911(b) amended section 1816 of the Social Security Act to remove the authority for groups or associations and individual providers of services to nominate (appoint) their intermediary. It also contains a description of CMS' rule that all providers and suppliers will generally be assigned to a MAC based on geographic location, but that large chain providers will be permitted to request the opportunity to consolidate their billing activities under the MAC with jurisdiction over the chain's home office. A PDF version of the final rule can be viewed at the A/B MAC Procurement and Implementation link to the left. Concept of Operations and Enterprise Architecture The Concept of Operations (ConOps) and Processing Claims for Part A and B Enterprise Architecture (EA) can be viewed by clicking on the A/B MAC Procurement and Implementation link to the left. These two documents are intended to provide potential bidders some key information they will need to develop proposals that effectively address CMS requirements. The ConOps document provides a high-level description of the business functions in the new fee-for-service (FFS) environment and of the agency's plans for performing them. It also includes both the business functions that the MAC will perform and those that other contractors will perform. The EA presents a detailed view of the FFS business, focusing on the functional and technical environments for processing FFS claims. Both of these documents describe the Medicare Part A and B environment as it will exist after the MAC contracts are awarded; it is not intended to represent the current environment of the FIs and carriers. J3 A/B MAC On July 31, 2006, CMS announced that it had awarded the Jurisdiction 3 (J3) A/B MAC contract to Noridian Administrative Services (NAS). As the J3 A/B MAC, NAS immediately began implementation activities and assumed full responsibility for the work in March 2007. A Background Sheet is available at the A/B MAC Procurement and Implementation link to the left. Cycle One A/B MACs In November 2005, CMS began the acquisition process for the seven A/B MAC jurisdictions that comprise Cycle One of the MAC procurement and transition schedule. Cycle One of the A/B MAC acquisitions included the following jurisdictions: J1, J2, J4, J5, J7, J12, and J13. CMS released two RFPs for Cycle One. The first RFP competed approximately 23% of the FFS workload under three A/B MAC jurisdictions: J4, J5 and J12. The second RFP competed about 22% of the FFS workload under jurisdictions J1, J2, J7, and J13. On August 2, 2007, CMS announced that it had awarded the J4 A/B MAC contract to Trailblazer Health Enterprises (Trailblazer). As the J4 A/B MAC, Trailblazer immediately began implementation activities and will assume full responsibility for the work no later than Spring 2008. A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. On September 5, 2007, CMS announced that it had awarded the J5 A/B MAC contract to Wisconsin Physicians Services Health Insurance Corporation (WPS). As the J5 A/B MAC, WPS immediately began implementation activities and will assume full responsibility for the work no later than September 9, 2008. A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. On October 24, 2007, CMS awarded the contract for the Jurisdiction 12 (J12) A/B MAC to Highmark Medicare Services, Inc. (HMS). J12 includes the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania. On November 5, 2007, Palmetto GBA filed a protest against the award with the Government Accountability Office (GAO). CMS notified GAO that the agency would take corrective action on certain aspects of the award decision. The result of this commitment by the agency to take corrective action on the initial evaluation and award was that Palmetto's protest was dismissed by GAO. The agency has completed its corrective action and has restored the contract award to HMS. As a result, CMS authorized HMS to resume work under J12 as of March 05, 2008. CMS expects HMS to assume full responsibility for the work by the end of 2008. A background sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. On October 25, 2007, CMS awarded the J1 A/B MAC contract to Palmetto GBA (Palmetto). J1 includes the states/territories of American Samoa, California, Guam, Hawaii, Nevada and the Northern Mariana Islands. On November 13, 2007, National Heritage Insurance Company (NHIC) filed a protest of the award with the Government Accountability Office (GAO) triggering an automatic stay on performance of work until a decision could be rendered. On February 12, 2007, CMS received notification that GAO denied NHIC's protest of the award to Palmetto. As a result of this decision, CMS authorized Palmetto to resume work under J1 as of February 14, 2008. CMS expects Palmetto to assume full responsibility for the work no later than October 1, 2008. A background sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. On March 18, 2008, CMS awarded the J13 A/B MAC contract to National Government Services (NGS). As the J13 A/B MAC, NGS will immediately begin implementation activities and will assume responsibility for the work no later than November 2008. A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. On May 06, 2008, CMS awarded the J2 A/B MAC contract to National Heritage Insurance Corporation (NHIC). However, on May 27, 2008 a protest against the award was filed with GAO. CMS is currently taking corrective action on certain aspects of the award decision. In the meantime, the current fiscal intermediaries and carriers will continue to provide Medicare claims processing services under their contracts. On June 11, 2008, CMS announced it had awarded the J7 A/B MAC contract to Pinnacle Business Solutions, Inc, (PBSI). However, on July 2, 2008 a protest against the award was filed with GAO. On October 6, 2008, GAO sustained the protest of the award and recommended corrective steps. As a result, CMS is taking corrective action on certain aspects of the award decision. For further information please visit GAO's website via the link below. Any inquiries concerning these RFPs should be directed to the contracting officers. Cycle Two A/B MACs The Cycle Two acquisition process involved separate competitions for seven A/B MAC jurisdictions. Cycle Two of the A/B MAC acquisitions included the following jurisdictions: J6, J8, J9, J10, J11, J14 and J15. In March 2007, CMS announced that the home health and hospice workloads would be consolidated into four of the A/B MAC contracts instead of being procured separately under Cycle Two. CMS will integrate the four home health and hospice jurisdictional claims workloads into the following four A/B MAC competitions: - Jurisdiction 6 will include home health and hospice Jurisdiction D,
- Jurisdiction 11 will include home health and hospice Jurisdiction C,
- Jurisdiction 14 will include home health and hospice Jurisdiction A and
- Jurisdiction 15 will include home health and hospice Jurisdiction B.
On August 31, 2007, CMS posted the two solicitations for Cycle Two on FedBizOpps. Links to these RFPs are available below. On September 12, 2008, CMS announced it had awarded the J9 A/B MAC contract to First Coast Service Options, Inc. (FCSO). As the J9 A/B MAC, FCSO will immediately begin implementation activities and will assume responsibility for the work no later than March 2009. A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. On November 19, 2008, CMS announced it had awarded the J14 A/B MAC contract to National Heritage Insurance Corporation (NHIC). As the J14 A/B MAC, NHIC will immediately begin implementation activities and will assume responsibility for the work no later than September 2009. NHIC's contract also includes the Regional Home Health and Hospice Intermediary (RHHI) workload in Jurisdiction A comprised of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. A Background Sheet and Qs & As related to the award are available at the A/B MAC Procurement and Implementation link to the left. On January 7, 2009, CMS announced it had awarded the remaining 5 Cycle Two A/B MAC contracts. Noridian Administrative Services, LLC (NAS) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 6 comprised of Illinois, Minnesota and Wisconsin. The contract also included the home health and hospice claims workload from providers in Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, U.S. Virgin Islands, Wisconsin and Washington. However, four protests against the award were filed with GAO. CMS is currently taking corrective action on certain aspects of the award decision. In the meantime, the current fiscal intermediaries and carriers will continue to provide Medicare claims processing services under their contracts. National Government Services, Inc (NGS) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 8 comprised of Indiana and Michigan. However, on January 26, 2009 a protest against the award was filed with GAO. GAO's decision on the protest must be issued no later than 100 days after the protest was filed. In this case, the deadline for the GAO decision on the protest is May 6, 2009. In accordance with the CICA, the filing of the protest triggered an automatic stay on performance of the NGS contract pending GAO's decision. Cahaba Government Benefit Administrators, LLC (Cahaba GBA) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 10 comprised of Alabama, Georgia and Tennessee. Palmetto Government Benefits Administrator, LLC (Palmetto GBA) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 11 comprised of North Carolina, South Carolina, Virginia and West Virginia. The contract also included the home health and hospice claims workload from providers in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas. However, on February 2, 2009 a protest against the award was filed with GAO. CMS is currently taking corrective action on certain aspects of the award decision. In the meantime, the current fiscal intermediaries and carriers will continue to provide Medicare claims processing services under their contracts. Highmark Medicare Services, Inc (HMS) was awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 15 comprised of Kentucky and Ohio. The contract also included the home health and hospice claims workload from providers in Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia and Wyoming. However, two protests against the award were filed with GAO. GAO's decision on the protests must be issued no later than 100 days after the protests were filed. In this case, the deadline for GAO's decision on the protests is May 2009. In accordance with the CICA, the filing of the protest triggered an automatic stay on performance of the HMS contract pending GAO's decision. These contractors will immediately begin implementation activities and will assume full responsibility for the claims processing work in their respective jurisdictions no later than March 2010. Background sheets and Qs & As related to the awards are available at the A/B MAC Procurement and Implementation link to the left. Click on the A/B MAC Procurement and Implementation link to the left to access the MAC Implementation handbook prepared by CMS to assist the A/B MACs in moving Medicare data records, and operational activities from current FIs and carriers so that they will be able to perform their Medicare contractual obligations.
Page Last Modified: 04/06/2009 7:32:43 AM
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