CMS delays transition to MACs in Regions D and C

Sunday, April 2, 2006

WASHINGTON - The transition from DMERCs to Medicare Administrative Contractors (MACs) in Regions D and C will be delayed three months from July 1 to Oct. 1, CMS stated late last month. The transition to MACs in Regions A and B will occur on July 1 as planned.

The delay in Regions C and D is the result of a protest filed by Cigna Government Services, the current Region D DMERC. Cigna, which bid on the MAC contracts in Regions C and D, lost the bids and then filed a protest with CMS.

The Government Accountability Office (GAO) will rule on the protest but is not expected to do so until May. That does not leave enough time to meet the July 1 transition deadline in Regions C and D, say industry watchers.

Palmetto GBA won the Region C MAC bid. Noridian Administrative Services won the Region D bid and replaced Cigna. Noridian and Palmetto have stopped work on the transition until the GAO rules on the protest.

The MACs are part of Medicare's reconfiguring of the DMERCs into two specialty contractors. The MACs will handle claims processing, customer service and other day-to-day operations. The Program Safeguard Contractors (PSA), overseen by a medical director, handle program integrity duties and assumed their duties March 1.

In awarding the MAC contracts, CMS stated that it chose companies that offered the best overall value to the government--in light of costs, technical qualifications and other considerations, such as past performance, corporate responsibility and their understanding of the special requirements involved in processing claims for medical equipment and prosthetics provided to beneficiaries.

Delaying the transition to MACs in Regions C and D is not all bad, say industry watchers.

It allows the MACs in Regions A and B to work out the bugs. That, in turn, may make the transitions in Regions C and D smoother, said industry attorney Asela Cuervo.

Additionally, while the GAO considers the protest, providers and other stakeholders can submit public comments for or against the companies involved. Those comments could influence how the GAO rules on the protest, said Michael Watson, vice president of government affairs for American Technologies.

"The protest is holding everything up, and that is why we want everyone to know they have a chance to comment and make a difference," Watson said.

According to Watson:

Providers must submit their input and include any evidence that they may have of good service or poor service. With their letters or e-mails, they must include the file number of the protest (B-297915.001) and the solicitation number (RFP-CMS-2005-0012). These letters or e-mails should be addressed to the GAO attorney handling the protest (Glenn Wolcott).

Emails can be sent to:
Mr. Glenn Wolcott
Government Accountability Office
44 "G" Street, NW
Washington, DC 20548