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Implementing Medicare contracting reform

Section 911(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Full Text Public Law 108-173 required the Secretary of the Department of Health and Human Services to begin implementing Medicare contracting reform in 2005 and to finish in 2011. To implement Medicare contracting reform, the Centers for Medicare & Medicaid Services (CMS) conducted full and open competitions for the work handled by fiscal intermediaries and carriers in administering the Medicare Fee-for-Service (FFS) program. The entities that were awarded contracts under these competitions are called Medicare Administrative Contractors (MACs). MACs serve as providers’ primary point-of-contact for the receipt, processing, and payment of Medicare FFS claims.

The original MAC contracting strategy in 2005 included 15 primary A/B MACs servicing the majority of provider types, four MACs servicing the Home Health and Hospice (HH+H) providers, and four MACs servicing suppliers of durable medical equipment (DME). Learn about the original strategy to implement Medicare contracting reform in the 2005 Report to Congress (PDF). Five years later CMS provided the status of implementing Medicare contracting reform and the revised strategy in the 2010 Report to Congress (PDF). There are also Archived Maps corresponding to each report.

CMS developed an acquisition plan based on Federal Acquisition Requirements (FAR) and over the course of several years solicited and awarded the MAC contracts. Round One included those jurisdictions awarded prior to September 1, 2010, and consisted of three phases: the Start-up Cycle, Cycle One and Cycle Two. Round Two included the procurements for jurisdictions that were reaching the end of the initial contract and two A/B MAC jurisdictions that were not successfully awarded in Round One.

From 2005-2006 the Round One Start-up Cycle included smaller and more stable workloads to allow CMS to examine its acquisition and transition plans and apply lessons learned to future procurement cycles. Round One, Start-up Cycle included the four DME jurisdictions: Jurisdiction A, Jurisdiction B, Jurisdiction C, Jurisdiction D and A/B MAC Jurisdiction 3.
From 2006-2008 Round One, Cycle One included: Jurisdiction 1, Jurisdiction 2, Jurisdiction 4, Jurisdiction 5, Jurisdiction 7, Jurisdiction 12, and Jurisdiction 13.
From 2007-2012 Round One, Cycle Two included: Jurisdiction 6, Jurisdiction 8, Jurisdiction 9, Jurisdiction 10, Jurisdiction 11, Jurisdiction 14 and Jurisdiction 15.
- In March 2007, prior to launching the Round One, Cycle Two acquisitions, CMS announced that the home health and hospice (HH+H) workloads would be consolidated into four of the A/B MAC contracts instead of being procured separately under Cycle Two. CMS integrated the four home health and hospice jurisdictional claims workloads into the following four A/B MAC competitions. See the current maps of the A/B MAC jurisdictions and the HH+H areas they serve at Who Are the MACs.
  - Jurisdiction 6 included HH+H region D
  - Jurisdiction 11 included HH+H region C
  - Jurisdiction 14 included HH+H region A
  - Jurisdiction 15 included HH+H region B

In July 2010 CMS posted a Request for Information (RFI) regarding MAC competitions and the jurisdiction consolidation plans. Specifically, CMS planned to consolidate the original 15 A/B MAC jurisdictions into 10 jurisdictions. As a result:
- Jurisdictions 2 and 3 were combined to form Jurisdiction F
- Jurisdictions 4 and 7 were combined to form Jurisdiction H
- Jurisdictions 13 and 14 were combined to form Jurisdiction K
- Jurisdictions 8 and 15 will be combined to form Jurisdiction I
- Jurisdictions 5 and 6 will be combined to form Jurisdiction G
- The remaining A/B MACs were renamed: Jurisdiction 1 became Jurisdiction E, Jurisdiction 10 became Jurisdiction J, Jurisdiction 11 became Jurisdiction M, Jurisdiction 12 became Jurisdiction L, and Jurisdiction 9 became Jurisdiction N.
In August 2010 CMS posted an RFI regarding the MAC Award Limit Policy.
From 2009-2015 Round Two included: Jurisdiction A, Jurisdiction B, Jurisdiction C, and Jurisdiction D, Jurisdiction E, Jurisdiction F, Jurisdiction G, Jurisdiction H, Jurisdiction I, Jurisdiction J, Jurisdiction K, Jurisdiction L, Jurisdiction M, and Jurisdiction N. Note: Round Two included the legacy workloads in Jurisdictions 2 and Jurisdiction 7, which were not awarded successfully in Round One.
In April 2014 CMS announced a pause in the consolidation activities prior to combining Jurisdictions 8 and 15 and Jurisdictions 5 and 6. For more information about the postponement decision please see the posting at RFI - Postponement of Final Two A/B MAC Contract Consolidations.

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Archived Maps

These maps depict the state of Medicare FFS contracting at specific points in time.

Pre-MMA FI-Carrier-DMERC-RHHI Maps 2004 (PDF): Maps showing the FIs, carriers, DMERCs, and RHHIs in place in 2004 before the implementation of Medicare contracting reform.
Original 15 A/B MAC Jurisdiction Map 2006 (PDF): Map of the original 15 A/B MAC jurisdictions described in the 2005 Report to Congress.
Original 4 DME MAC Jurisdiction Map 2006 (PDF): Map of the original four DME MAC jurisdictions described in the 2005 Report to Congress.
Original 4 HH+H Jurisdiction Map 2006 (PDF): Map of the original HH+H jurisdictions described in the 2005 Report to Congress.
Consolidated A/B MAC Jurisdictions Map 2010 (PDF): Map showing the consolidated 10 A/B MAC jurisdictions described in the 2010 Report to Congress.
See maps of the current MAC jurisdictions at Who Are the MACs.

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