Spotlight

Status of MAC Contract Awards (as of February 26, 2013)

Protest Updates: On January 18, 2013, the Government Accountability Office (GAO) denied the two protests that had been pending against the Jurisdiction E A/B MAC contract award to Noridian Administrative Services since October 2012.  As permitted by law, both protestors filed complaints challenging the Jurisdiction E MAC contract award with the U.S. Court of Federal Claims on February 1, 2013.  The Department of Justice is representing CMS before the Court.  For at least the next several months, Medicare providers in California, Hawaii, Nevada, and the Pacific territories will continue to file their Medicare claims with the incumbent A/B MAC (Palmetto GBA).  CMS will notify affected Medicare providers about the situation, including any implementation dates, following the Court of Federal Claims review.

On October 9, 2012, CMS received notification that two protests have been filed against the Jurisdiction 6 A/B MAC contract that was awarded to National Government Services on September 27.  GAO completed its review of the procurement record on January 16, 2013, and denied both protests.  CMS will now move forward to implement the Jurisdiction 6 MAC contract; CMS expects the implementation process to be completed by early September 2013.  The implementation schedule can be accessed by clicking on the following link:  Jurisdiction 6 Implementation Schedule.  CMS and National Government Services will notify the affected Medicare providers concerning any actions that must be taken to support the implementation.  While the new Jurisdiction 6 MAC contract is implemented, the current Medicare fiscal intermediaries and carriers will continue to administer Medicare payments to providers of Illinois, Minnesota, and Wisconsin.

On October 2, 2012, CMS was notified that a protest has been filed against the Jurisdiction L A/B MAC contract that was awarded to Novitas Solutions, Inc., on September 17.  In keeping with federal procurement law, CMS has issued a stop work order for the Jurisdiction L contract, to allow the GAO to review the procurement record. Due to a second protest received on January 8, 2013, the stop work order will be in effect through mid-April.  During the GAO review, Novitas will continue to administer Medicare payments to providers in Jurisdiction L (the states of Delaware, Maryland, New Jersey, and Pennsylvania, as well as the District of Columbia) under an existing contract.

On September 18, 2012, CMS received notification that a protest was filed against the DME MAC C contract award that was made to CGS Administrators, LLC, on August 31.  GAO completed its review of the procurement record and denied the protest on December 21, 2012.  CMS is moving forward with the implementation of the new contract, which is expected to be completed by April 30, 2013. During this period, CGS Administrators will continue to administer Medicare payments to DME suppliers in Jurisdiction C under an existing contract.

Award Announcements:  On February 22, 2013, CMS made a contract award for the Jurisdiction K A/B MAC to National Government Services, Inc. (NGS).  The Jurisdiction K A/B MAC will administer Medicare Part A and Part B claims for covered services in the states of Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont. The new A/B MAC contract replaces two separate A/B MAC contracts now in effect that were awarded in 2008.  NGS will be subcontracting several significant functions to NHIC Corp. (NHIC) under the new Jurisdiction K A/B MAC contract.  CMS issued the solicitation for the new Jurisdiction K A/B MAC contract in May 2012; inclusive of all options, the awarded contract has an estimated value of $493.2 million.  For more information about the Jurisdiction K contract award, use the following hyperlink: Jurisdiction K Award Fact Sheet

On September 27, 2012, CMS made a contract award for the Jurisdiction 6 A/B MAC to National Government Services, Inc (NGS).  The Jurisdiction 6 A/B MAC administers Medicare Part A and Part B claims for covered services in the states of Illinois, Minnesota, and Wisconsin.  This contractor will also administer Medicare billings from home health and hospice providers in thirteen states and five U.S. territories.  The current Medicare fiscal intermediaries and carriers for these Medicare workloads (in addition to NGS, Wisconsin Physicians Service and Noridian Administrative Services currently service some of the Medicare claims to be transferred to the new contract) will continue in their responsibilities for several months while CMS and NGS implement the new contract. Jurisdiction 6 Implementation Schedule  For more information about the Jurisdiction 6 MAC contract award, use the following hyperlink:  Jurisdiction 6 Award Fact Sheet.  All protests against the Jurisdiction 6 MAC contract award were resolved on January 16, 2013, and CMS and NGS will now implement the new contract by early September 2013 (see Protest Updates, above).

On September 20, 2012, CMS made a contract award for the Jurisdiction E A/B MAC contract to Noridian Administrative Services.  The Jurisdiction E A/B MAC administers Medicare Part A and Part B claims for covered services in the California, Hawaii, and Nevada, as well as the U.S. territories of American Samoa, Guam, and the Northern Mariana Islands.  The current A/B MAC for this geographic area, Palmetto GBA, will continue to administer provider claims until CMS completes the transfer of these Medicare contract responsibilities to Noridian Administrative Services.  Two protestors have filed complaints with the U.S. Court of Federal Claims regarding this Jurisdiction E MAC contract award (see Protest Updates, above).   For more information about the Jurisdiction E award, use the following hyperlink:  Jurisdiction E Award Fact Sheet.  

On September 17, 2012, CMS made a contract award for the Jurisdiction L A/B MAC contract to Novitas Solutions, Inc.  The Jurisdiction L A/B MAC administers Medicare Part A and Part B claims for covered services in the states of Delaware, Maryland, New Jersey, and Pennsylvania, as well as the District of Columbia.  For more information about the Jurisdiction L award, use the following hyperlink:  Jurisdiction L Award Fact Sheet.  The contract award has been protested (see Protest Updates, above). 

On August 31, 2012, CMS made a contract award for the Jurisdiction C Durable Medical Equipment (DME) MAC contract to CGS Administrators, LLC.  The Jurisdiction C DME MAC administers Medicare supplier claims for DME furnished to program beneficiaries who reside in the states of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia, as well as Puerto Rico and the U.S. Virgin Islands.  The contract award was protested, but GAO has resolved the protest and CMS is now implementing the contract. (see Protest Updates, above). For more information about the Jurisdiction C award, use the following hyperlink:  Jurisdiction C Award Fact Sheet

General Status of MAC Procurements:  During initial implementation (2005-2010) of MAC procurements, Medicare's claims processing operations have realized significant operational savings from the consolidation of state workloads and the efficiencies gained through integrating Part A and Part B functionality.  CMS believes that the efficiency and effectiveness of its contracted Medicare claims operations can be further increased by consolidating some of the smaller A/B MAC workloads to form larger A/B MAC jurisdictions, further reducing the size range among the A/B MACs.  In addition, CMS believes that reducing the number of A/B MAC contracts to ten will improve the efficiency and effectiveness of CMS's internal MAC procurement and contract administration processes.

To achieve its ultimate goal of ten A/B MAC contracts, CMS intends to:

• Re-compete five A/B MAC contracts/jurisdictions based on their present area boundaries as the current A/B MAC contracts run their course; and
• Over the next several years, consolidate five pairs of A/B MAC workloads to form five consolidated A/B MAC contracts.

The approximate timing for each consolidation is addressed in the table below, although the exact timing of consolidation actions may be adjusted based on program considerations (contractual status, schedule, etc.).

For more information on the status of the A/B MAC awards click on the Part A/Part B Medicare Administrative Contractor link to the left.  For a map of the DME MAC and Home Health and Hospice jurisdictions click on the Specialty MAC Jurisdiction link to the left.

WPS/Legacy Part A Workload Transfer (West Coast Providers (CA-HI-NV), Southwestern Providers (TX-OK-NM-CO), and Mid-Atlantic Providers (DC-DE-MD-NJ-PA) Formerly Serviced by Mutual of Omaha)

In keeping with CMS policy for assigning providers to A/B MACs, CMS re-assigned three sets of providers from the WPS legacy fiscal intermediary contract to their destination A/B MACs during calendar 2010 and early 2011.  Please see the Medicare Learning Network article link below for more detail.

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