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Medicare Information Resource

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Medicare Information Resource Part A and B Combined
MIR-2006-9AB, September 2006

Planned Release of a Request for Information (RFI) Concerning The Scope of Work and Specialty Activities that CMS Will Include in the Next Medicare Administrative Contractor (MAC) Procurements (PE200608-03)

CMS announced on July 31, 2006 the awarding of the first of 15 contracts for the combined administration of Part A and Part B claims activities in a multi-state jurisdiction. That first Medicare Administrative Contractor (MAC) award was for the six-state jurisdiction of Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming (Jurisdiction 3).

CMS has 14 more Part A/Part B MAC contracts to acquire through the competitive process. These procurements will be conducted in two cycles. Cycle One of the A/B MAC acquisitions will be for seven jurisdictions, accounting for approximately 45 percent of the Part A/Part B fee-for-service claims workload. CMS will conduct these seven competitions in two rounds.

The first round of competitions under Cycle One will cover three jurisdictions:

  • J4 ( Colorado, Oklahoma, New Mexico, and Texas)
  • J5 ( Iowa, Kansas, Missouri, and Nebraska)
  • J12 ( Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania)

The Request for Proposal for this first round of competitions under Cycle One will include mandatory options for the following specialty activities:

  • Indian Health Services for J4
  • Veterans Affairs Medicare Equivalent Remittance Advice for J4
  • Centralized Billing for Mass Immunizers and for J4
  • Rural Community Hospitals which will also be required for J4 and J5

On Wednesday, August 9, 2006, CMS will publish on the Federal Business Opportunities Web site ( www.FedBizOpps.gov )External Link a Request for Information (RFI) containing the planned Statement of Work (SOW) for the second round of competitions under Cycle One. Public comments will be due on Thursday, August 31. CMS encourages everyone to review the RFI and provide comments or questions. You will find guidance on how/where to submit comments and questions about the RFI on that same FedBizOpps site.

The second round of competitions under Cycle One will include the remaining jurisdictions:

  • J1 ( American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands)
  • J2 ( Alaska, Idaho, Oregon and Washington)
  • J7 ( Arkansas, Louisiana and Mississippi)
  • J13 ( Connecticut and New York)

The RFP for this second round of competition will include the following mandatory options:

  • Competitive Acquisition Program for Part B Drugs (CAP)
  • Rural Community Hospital for J1, and J2

To learn more about the transition to the A/B MAC environment, please visit the Medicare Contracting Reform Web site at: http://www.cms.hhs.gov/MedicareContractingReform/. External Link

CMS Learn Resource 200608-03

 

 

   
 
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