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MAC Performance Compliance

The Medicare Access and CHIP Reauthorization Act of 2015 sets forth a provision in Section 509 that requires contractor performance transparency to the extent possible without compromising the process for entering into and renewing contracts with Medicare Administrative Contractors (MAC).  Under this section, the Secretary shall make available to the public the performance of each MAC with respect to such performance requirements and measurement standards.

As per FAR 46.401 Government contract quality assurance shall be performed at such times and places to determine that the supplies or services conform to contract requirements. Quality assurance surveillance plans (QASP) should be prepared in conjunction with the preparation of the Statement of Work (SOW). The QASP’s purpose is to measure the MAC's compliance with the SOW requirements (QASP reviews cover a major subset of the SOW requirements but does not cover an exhaustive list of SOW requirements for each MAC. The Overall Performance Compliance percentages below represent a cumulative value of contract standards considered to be met as part of the CMS QASP.

Please note that data only includes select QASP standards and metrics that are evaluated across all MAC contracts for a specific fiscal year, and metrics may vary from year to year for performance oversight purposes. In FY2014 MACs were evaluated on approximately 122 performance metrics/requirements for Part A/B and 76 performance metrics/requirements for DME. In FY2015, FY2016 and FY2017, MACs were evaluated on approximately 80 performance metrics/requirements for Part A/B and 50 performance metrics/requirements for DME. For reporting purposes, the fiscal year is determined based on the MACs period of performance end date.

Performance Compliance:  

Fiscal Year 2017: October 1, 2016 - September 30, 2017

MAC Jurisdiction Overall Performance Compliance
15 92%
5 84%
6 90%
8 89%
A 95%
B 94%
C 92%
D 92%
E 90%
F 92%
H 89%
J 77%
K 98%
L 85%
M 84%
N 80%

This graph displays the MAC Compliance rates by Jurisdiction for Fiscal Year 2017. The graph is a bar graph with Jurisdictions along the X axis and Overall performance compliance scores (in percentages) along the Y axis. There is one bar per Jurisdiction along with one horizontal bar drawn across the entire graph that displays the average of all of the Jurisdiction scores. The data points are as follows (Jurisdiction followed by compliance score): 15-92%, 5-84%, 6-90%, 8-89%, A-95%, B-94%, C-92%, D-92%, E-90%, F-92%, H-89%, J-77%, K-98%, L-85%, M-84%, N-80%. The average (horizontal bar) is 89%.

Fiscal Year 2016: October 1, 2015 - September 30, 2016

MAC Jurisdiction Overall Performance Compliance
15 94%
15 91%
5 89%
6 83%
8 90%
A 91%
B 92%
C 96%
D 98%
D 96%
E 86%
F 91%
H 90%
J 73%
K 88%
L 95%
M 90%
N 88%

Alt Text: This graph displays the MAC Compliance rates by Jurisdiction for Fiscal Year 2016.  The graph is a bar graph with Jurisdictions along the X axis and Overall performance compliance scores (in percentages) along the Y axis.  There is one bar per Jurisdiction along with one horizontal bar drawn across the entire graph that displays the average of all of the Jurisdiction scores.  The data points are as follows (Jurisdiction followed by compliance score): 15-94%, 15-91%, 5-89%, 6-83%, 8-90%, A-91%, B-92%, C-96%, D-98%, D-96%, E-86%, F-91%, H-90%, J-73%, K-88%, L-95%, M-90%, N-88%.  The average (horizontal bar) is 90%.

* Jurisdictions 15 and D had two contract periods end within FY2016

Fiscal Year 2015: October 1, 2014 - September 30, 2015

MAC Jurisdiction Overall Performance Compliance
10 74%
11 85%
15 81%
5 91%
6 76%
8 85%
A 94%
B 87%
C 87%
D 100%
E 71%
F 88%
H 80%
K 76%
L 79%
N 77%

This graph displays the MAC Compliance rates by Jurisdiction for Fiscal Year 2015.  The graph is a bar graph with Jurisdictions along the X axis and Overall performance compliance scores (in percentages) along the Y axis.  There is one bar per Jurisdiction along with one horizontal bar drawn across the entire graph that displays the average of all of the Jurisdiction scores.  The data points are as follows (Jurisdiction followed by compliance score): 10 – 74%, 11 – 85%, 15 – 81%, 5 – 91%, 6 – 76%, 8 – 85%, A – 94%, B – 87%, C – 87%, D – 100%, E – 71%, F – 88%, H – 80%, K – 76%, L – 79%, N – 77%.  The average (horizontal bar) is 83%.