CMS has announced plans to consolidate the current 15 A/B Medicare Administrative Contractor (MAC) jurisdictions into 10 jurisdictions in the second round of re-bidding of the MAC contracts beginning in late 2011. In addition to consolidating the existing 15 A/B MAC jurisdictions into 10 jurisdictions, CMS intends to re-designate the 10 jurisdictions by “letter” rather than by “number.” CMS expects to complete the awarding of Round II contracts and the resulting consolidation and renaming of MAC jurisdictions by 2016.

Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required CMS to replace the Medicare claims payment contractors, fiscal intermediaries (FIs) and carriers, with new administrative entities called MACs. The MMA requires CMS to re-bid each of its MAC contracts every five years. Because the first MAC contracts were awarded by CMS in 2006, the contracts awarded in the first cycle of Round I procurements are due to be re-bid by the end of this year. At present, CMS has fully implemented 9 of the 15 A/B MAC contracts, while 6 of the contracts have not yet been implemented due to bid protests or procurement corrective actions.

In the Round II re-bidding of the MAC contracts, CMS will create the following consolidated A/B MAC jurisdictions:

  • Jurisdiction F, comprised of former jurisdictions 2 and 3 (covering Alaska, Washington, Oregon, Idaho, North Dakota, South Dakota, Montana, Wyoming, Utah, and Arizona);
  • Jurisdiction G, comprised of former jurisdictions 5 and 6 (covering Minnesota, Wisconsin, Illinois, Kansas, Nebraska, Iowa, and Missouri);
  • Jurisdiction H, comprised of former jurisdictions 4 and 7 (covering Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado, and New Mexico);
  • Jurisdiction I, comprised of former jurisdictions 8 and 15 (covering Kentucky, Ohio, Michigan, and Indiana); and
  • Jurisdiction K, comprised of former jurisdictions 13 and 14 (covering New York, Connecticut, Massachusetts, Rhode Island, Vermont, Maine, and New Hampshire).

 Five A/B MAC jurisdictions will not be further consolidated: jurisdiction 1 will become new jurisdiction E (covering California, Hawaii, Nevada, Pacific Islands); jurisdiction 9 will become new jurisdiction N (covering Florida, Puerto Rico, US Virgin Islands); jurisdiction 10 will become new jurisdiction J (covering Alabama, Georgia, Mississippi, Tennessee); jurisdiction 11 will become new jurisdiction M (covering North Carolina, South Carolina, Virginia, West Virginia); and jurisdiction 12 will become new jurisdiction L (covering Delaware, Maryland, Pennsylvania, New Jersey, Washington, D.C.).

The consolidation of A/B MAC jurisdictions will commence with the re-bidding of implemented A/B MAC contracts and will be completed over the next five years. Round II solicitations for the jurisdictions to be consolidated will specify a target date for implementing the existing jurisdictional workload in each pairing, which will coincide with the end date of the existing A/B MAC whose contract will expire first. The new solicitations will also designate a target date for integrating the second jurisdictional workload in each pairing into the consolidated A/B MAC, which will coincide with the second jurisdiction’s contract end date.

More information regarding MAC contracting reform and the consolidation of the MAC jurisdictions is available by clicking here and here. A map showing the consolidated MAC jurisdictions is available by clicking here.