Medicare Program; Request for Information Regarding the Awarding and the Administration of Medicare Administrative Contractor Contracts, 79343-79345 [2015-32027]
Download as PDF
<![CDATA[
Federal Register / Vol. 80, No. 244 / Monday, December 21, 2015 / Notices
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[Docket No. CDC–2015–0001]
Final Revised Vaccine Information
Materials for Multiple Pediatric
Vaccines (‘‘Your Child’s First
Vaccines’’)
Centers for Disease Control and
Prevention (CDC), Department of Health
and Human Services (HHS)
ACTION: Notice
AGENCY:
Under the National
Childhood Vaccine Injury Act
(NCVIA)(42 U.S.C. 300aa–26), the CDC
must develop vaccine information
materials that all health care providers
are required to give to patients/parents
prior to administration of specific
vaccines. On January 9, 2015, CDC
published a notice in the Federal
Register (80 FR 1416) seeking public
comments on proposed updated vaccine
information materials for multiple
pediatric vaccines (‘‘Your Baby’s First
Vaccines’’). Following review of
comments submitted and consultation
as required under the law, CDC has
finalized the materials. A copy of the
final vaccine information materials for
multiple pediatric vaccines (‘‘Your
Child’s First Vaccines’’) is available to
download from https://www.cdc.gov/
vaccines/hcp/vis/ or https://
www.regulations.gov (see Docket
Number CDC–2015–0001).
DATES: Beginning no later than March 1,
2016, each health care provider who
chooses to use the multiple pediatric
vaccines Vaccine Information Statement
(‘‘Your Child’s First Vaccines’’) when
administering multiple pediatric
vaccines to any child in the United
States shall provide copies of the
relevant vaccine information materials
contained in this notice rather than the
previous edition (dated October 22,
2014) in conformance with the
November 5, 2015 CDC Instructions for
the Use of Vaccine Information
Statements prior to providing such
vaccinations.
SUMMARY:
mstockstill on DSK4VPTVN1PROD with NOTICES
FOR FURTHER INFORMATION CONTACT:
Suzanne Johnson-DeLeon (msj1@
cdc.gov), National Center for
Immunization and Respiratory Diseases,
Centers for Disease Control and
Prevention, Mailstop A–19, 1600 Clifton
Road NE., Atlanta, Georgia 30329.
SUPPLEMENTARY INFORMATION: The
National Childhood Vaccine Injury Act
of 1986 (Pub. L. 99–660), as amended by
section 708 of Public Law 103–183,
VerDate Sep<11>2014
17:38 Dec 18, 2015
Jkt 238001
added section 2126 to the Public Health
Service Act. Section 2126, codified at 42
U.S.C. 300aa–26, requires the Secretary
of Health and Human Services to
develop and disseminate vaccine
information materials for distribution by
all health care providers in the United
States to any patient (or to the parent or
legal representative in the case of a
child) receiving vaccines covered under
the National Vaccine Injury
Compensation Program (VICP).
Development and revision of the
vaccine information materials, also
known as Vaccine Information
Statements (VIS), have been delegated
by the Secretary to the Centers for
Disease Control and Prevention (CDC).
Section 2126 requires that the materials
be developed, or revised, after notice to
the public, with a 60-day comment
period, and in consultation with the
Advisory Commission on Childhood
Vaccines, appropriate health care
provider and parent organizations, and
the Food and Drug Administration. The
law also requires that the information
contained in the materials be based on
available data and information, be
presented in understandable terms, and
include:
(1) A concise description of the
benefits of the vaccine,
(2) A concise description of the risks
associated with the vaccine,
(3) A statement of the availability of
the National Vaccine Injury
Compensation Program, and
(4) Such other relevant information as
may be determined by the Secretary.
The vaccines initially covered under
the National Vaccine Injury
Compensation Program were diphtheria,
tetanus, pertussis, measles, mumps,
rubella and poliomyelitis vaccines.
Since April 15, 1992, any health care
provider in the United States who
intends to administer one of these
covered vaccines is required to provide
copies of the relevant vaccine
information materials prior to
administration of any of these vaccines.
Since then, the following vaccines have
been added to the National Vaccine
Injury Compensation Program, requiring
use of vaccine information materials for
them as well: Hepatitis B, Haemophilus
influenzae type b (Hib), varicella
(chickenpox), pneumococcal conjugate,
rotavirus, hepatitis A, meningococcal,
human papillomavirus (HPV), and
seasonal influenza vaccines.
Instructions for use of the vaccine
information materials are found on the
CDC Web site at: https://www.cdc.gov/
vaccines/hcp/vis/.
PO 00000
Frm 00042
Fmt 4703
Sfmt 4703
79343
Revised Vaccine Information Materials
The multiple pediatric vaccines
information materials referenced in this
notice were developed in consultation
with the Advisory Commission on
Childhood Vaccines, the Food and Drug
Administration, and parent and
healthcare provider organizations.
Following consultation and review of
comments submitted, the vaccine
information materials covering multiple
pediatric vaccines (‘‘Your Child’s First
Vaccines’’) have been finalized and are
available to download from https://www.
cdc.gov/vaccines/hcp/vis/ or
https://www.regulations.gov (see Docket
Number CDC–2015–0001). The Vaccine
Information Statement (VIS) is ‘‘Your
Child’s First Vaccines: What You Need
to Know’’ (publication date November 5,
2015).
With publication of this notice, as of
March 1, 2016, all health care providers
who choose to use the multiple
pediatric vaccines Vaccine Information
Statement (‘‘Your Child’s First
Vaccines’’) when administering
multiple pediatric vaccines to any child
in the United States shall provide copies
of the relevant vaccine information
materials contained in this notice rather
than the previous edition (dated October
22, 2014) in conformance with CDC’s
November 5, 2015 Instructions for the
Use of Vaccine Information Statements.
Dated: December 16, 2015.
Sandra Cashman,
Executive Secretary, Centers for Disease
Control and Prevention.
[FR Doc. 2015–31990 Filed 12–18–15; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1653–NC]
Medicare Program; Request for
Information Regarding the Awarding
and the Administration of Medicare
Administrative Contractor Contracts
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Request for information.
AGENCY:
This request for information
solicits public comment on the
processes and procedures that we could
use to leverage new legal authorities
to— incentivize and reward exceptional
Medicare Administrative Contractor
(MAC) contract performance; publish
performance information on each MAC,
SUMMARY:
E:\FR\FM\21DEN1.SGM
21DEN1
79344
Federal Register / Vol. 80, No. 244 / Monday, December 21, 2015 / Notices
to the extent permitted by law; and
make MAC jurisdictional changes.
DATES: To be assured consideration,
written or electronic comments must be
received at one of the addresses
provided below, no later than 5 p.m. on
February 19, 2016.
ADDRESSES: In commenting, refer to file
code CMS–1653–NC. Because of staff
and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
You may submit comments in one of
four ways (please choose only one of the
ways listed):
1. Electronically. You may submit
electronic comments on this regulation
to https://www.regulations.gov. Follow
the ‘‘Submit a comment’’ instructions.
2. By regular mail. You may mail
written comments to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–1653–NC, P.O. Box 8013,
Baltimore, MD 21244–8013.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments to the
following address ONLY: Centers for
Medicare & Medicaid Services,
Department of Health and Human
Services, Attention: CMS–1653–NC,
Mail Stop C4–26–05, 7500 Security
Boulevard, Baltimore, MD 21244–1850.
4. By hand or courier. Alternatively,
you may deliver (by hand or courier)
your written comments ONLY to the
following addresses: a. For delivery in
Washington, DC—Centers for Medicare
& Medicaid Services, Department of
Health and Human Services, Room 445–
G, Hubert H. Humphrey Building, 200
Independence Avenue SW.,
Washington, DC 20201.
mstockstill on DSK4VPTVN1PROD with NOTICES
(Because access to the interior of the
Hubert H. Humphrey Building is not readily
available to persons without Federal
government identification, commenters are
encouraged to leave their comments in the
CMS drop slots located in the main lobby of
the building. A stamp-in clock is available for
persons wishing to retain a proof of filing by
stamping in and retaining an extra copy of
the comments being filed.)
b. For delivery in Baltimore, MD—
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, 7500 Security
Boulevard, Baltimore, MD 21244–1850.
If you intend to deliver your
comments to the Baltimore address, call
telephone number (410) 786–9994 in
advance to schedule your arrival with
one of our staff members.
Comments erroneously mailed to the
addresses indicated as appropriate for
VerDate Sep<11>2014
17:38 Dec 18, 2015
Jkt 238001
hand or courier delivery may be delayed
and received after the comment period.
FOR FURTHER INFORMATION
CONTACT: Debra Bowman, (410) 786–
4941. Phyllis Atkins-Mackey, (410) 786–
9362. Megan Martino, (215) 861–4425.
Sue Pelella, (215) 861–4245.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following Web
site as soon as possible after they have
been received: https://
www.regulations.gov. Follow the search
instructions on that Web site to view
public comments.
Comments received timely will also
be available for public inspection as
they are received, generally beginning
approximately 3 weeks after publication
of a document, at the headquarters of
the Centers for Medicare & Medicaid
Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday
through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an
appointment to view public comments,
phone 1–800–743–3951.
I. Background
For several decades after Medicare’s
inception in 1966, private health care
insurers, known as Part A Fiscal
Intermediaries (FI) and Part B carriers,
processed medical claims for Medicare
beneficiaries. Section 911 of the
Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (MMA) (Pub. L. 108–173) added
section 1874A to the Social Security Act
(the Act) to require the Secretary of
Health and Human Services (the
Secretary) to replace Part A FIs and Part
B carriers with Medicare Administrative
Contractors (MACs). This contracting
reform was intended to improve
Medicare’s administrative services to
beneficiaries and health care providers
through the use of new contracting
tools, including competition and
performance incentives.
Currently, we award MAC contracts
through use of competitive procedures
in accordance with the Federal
Acquisition Regulation (FAR). As
authorized by the MMA, we established
MACs as multistate, regional contractors
responsible for administering both
Medicare Part A and Medicare Part B
claims. The transition from the Part A
FIs and Part B carriers to MACs began
in 2006, and the last FI and carrier
PO 00000
Frm 00043
Fmt 4703
Sfmt 4703
contractor operations ended by
September 2013.
We rely on a network of 16 MACs to
process Medicare claims, including 12
MACs that administer both Part A and
Part B claims and 4 MACs that
specialize in administering Part B
claims for durable medical equipment,
prosthetics, orthotics, and supplies.
MACs serve as the primary operational
contact between the Medicare Fee-ForService (FFS) program and
approximately 1.5 million health care
providers and suppliers enrolled in the
program. MACs process Medicare
claims, enroll health care providers and
suppliers in the Medicare program,
educate providers and suppliers on
Medicare billing requirements, and
answer provider and supplier inquiries.
Collectively, the MACs process nearly
4.9 million Medicare claims each
business day and disburse more than
$365 billion annually in program
payments.
Section 509(a) of the Medicare Access
and CHIP Reauthorization Act of 2015
(MACRA) (Pub. L. 114–10) extended the
maximum length of a MAC contract,
inclusive of all option and renewal
periods, from 5 years to 10 years.
Section 509(c) of MACRA added a
clause to section 1874A(b)(3)(A) of the
Act that requires the Secretary, to the
extent possible without compromising
the process for entering into and
renewing contracts with MACs, to make
available to the public the performance
of each MAC with respect to such
performance requirements and
measurement standards.
II. Provisions of the Request for
Information
The Government Accountability
Office (GAO) has recently noted that,
now that we have accomplished the
major milestone of fully implementing
and transitioning to the MAC
environment, we have the opportunity
to consider whether some additional
contracting mechanisms could be
utilized to further improve MAC
performance. Consistent with the new
authority provided under MACRA and
the recommendation provided by GAO,
we are evaluating numerous elements of
our MAC acquisition strategy, including
potential adjustments to our MAC
contract terms and conditions. The
scope of our evaluation includes the
processes and procedures that we use
for awarding the MAC contracts and
administering the MAC contracts after
award.
We currently use a cost-plus-awardfee contract type for the MAC contracts,
meaning that MACs are financially
incentivized and rewarded with
E:\FR\FM\21DEN1.SGM
21DEN1
mstockstill on DSK4VPTVN1PROD with NOTICES
Federal Register / Vol. 80, No. 244 / Monday, December 21, 2015 / Notices
additional fee/profit for exceptional
performance in areas critical to the
success of the Medicare FFS program.
For example, and specific to provider
satisfaction, we currently measure,
evaluate, and reward MACs for the
quality (accuracy, completeness,
customer skills, and adherence to the
Privacy Act of 1974) of their customer
service representatives’ responses to
provider telephone calls and the
providers’ level of satisfaction with the
MAC’s Web site. The amount of award
fee earned by the MAC is based on our
comprehensive evaluation of the MAC’s
performance against specific, written
quality measures and evaluation
criteria.
Prior to the enactment of MACRA, the
law required that MAC contracts be
recompeted no less frequently than once
every 5 years, which created the
potential for frequent turnover in these
critical contracts and disruption for
Medicare providers and suppliers. With
the enactment of MACRA, we are now
able to renew a MAC contract for up to
10 years and reduce the potential for
frequent turnover if the MAC meets or
exceeds our performance objectives;
conversely, we may still utilize
competitive procedures sooner than 10
years in the event that a MAC does not
meet our performance objectives. In
concert with or in (partial or full)
replacement of our award fee process,
we are considering incorporating an
‘‘award term’’ concept into MAC
contracting, meaning that we may
incentivize and reward consistently,
well-performing MACs with a longerterm contract (but not longer than 10
years). For example, MACs that
consistently exceed our performance
standards may be rewarded with a
longer-term contract (up to 10 years);
whereas, MACs that do not consistently
exceed our performance standards may
be limited to a shorter-term contract
(more or less than 5 years). Therefore,
we are soliciting public comment on the
following questions regarding MAC
incentives for exceptional performance:
• Do you have any concerns or
suggestions related to development of a
potential ‘‘award term’’ strategy and
plan?
• Do you have any other suggestions
for incentivizing and rewarding
exceptional MAC performance?
• Are there any specific metrics or
evaluation criteria that would be
valuable in measuring the level and
quality of the service provided by a
MAC?
• Are there any specific metrics or
evaluation criteria that would be
valuable in measuring the level and
quality of the MAC’s relationships
VerDate Sep<11>2014
17:38 Dec 18, 2015
Jkt 238001
(including education and outreach) with
providers?
Section 509(c) of MACRA directs us
to make some MAC performance metrics
available to the public, to the extent that
doing so can be done in a manner that
does not compromise the competitive
procurement process. Therefore, we are
requesting comment on the following
questions regarding MAC performance
transparency:
• With regard to the MAC’s quality
and level of service and performance,
what types or kinds of information
should be published for public release?
• If we were to publish the results of
the evaluation of a MAC’s performance
on our Web site, which types of metrics
or information should be made available
for public release?
We are also soliciting public comment
on potential MAC jurisdictional
changes. Currently, there are 12 A/B
MAC jurisdictions; in 2010, we
announced a plan to consolidate FFS
claims operations to 10 A/B MAC
jurisdictions over the course of several
years. However, in 2014, we announced
that we were postponing the
consolidation of Jurisdictions 8 (which
encompasses the states of Indiana and
Michigan) and 15 (which encompasses
Kentucky and Ohio) to form
‘‘Jurisdiction I’’ and the consolidation of
Jurisdictions 5 (Iowa, Kansas, Missouri
and Nebraska) and 6 (Illinois,
Minnesota, and Wisconsin) to form
‘‘Jurisdiction G.’’ For more information
on our 2010 strategy for consolidating
A/B MAC jurisdictions, as well as our
2014 decision to postpone the final 2
jurisdictional consolidations, see
https://www.cms.gov/Medicare/
Medicare-Contracting/MedicareAdministrative-Contractors/Downloads/
RFI-Announcement-AB–MAC-March2014.pdf
Accordingly, we are requesting
comment on the following question:
• What would the advantages and
disadvantages be if CMS completed the
last two MAC consolidations?
III. Collection of Information
Requirements
This request for information
document does not impose any
information collection requirements. In
accordance with the implementing
regulations of the Paperwork Reduction
Act of 1995 (PRA) at 5 CFR 1320.3(h)(4),
we believe it is a general solicitation of
comments from the public. Therefore, it
is exempt from the requirements of the
PRA (44 U.S.C. 3501 et seq.).
IV. Response to Comments
Because of the large number of public
comments we normally receive on
PO 00000
Frm 00044
Fmt 4703
Sfmt 4703
79345
Federal Register documents, we are not
able to acknowledge or respond to them
individually. We will consider all
comments we receive by the date and
time specified in the DATES section of
this preamble, and, when we issue a
subsequent document, we will respond
to the comments in the preamble to that
document.
Dated: November 23, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare
& Medicaid Services.
[FR Doc. 2015–32027 Filed 12–18–15; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2015–N–0001]
Allergenic Products Advisory
Committee; Notice of Meeting
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
This notice announces a forthcoming
meeting of a public advisory committee
of the Food and Drug Administration
(FDA). The meeting will be open to the
public.
Name of Committee: Allergenic
Products Advisory Committee.
General Function of the Committee:
To provide advice and
recommendations to the Agency on
FDA’s regulatory issues.
Date and Time: The meeting will be
held on January 21, 2016, from 8:30 a.m.
to 4 p.m.
Location: FDA White Oak Campus,
10903 New Hampshire Ave., Bldg. 31
Conference Center, the Great Room (rm.
1503), Silver Spring, MD 20993–0002.
Answers to commonly asked questions
including information regarding special
accommodations due to a disability,
visitor parking, and transportation may
be accessed at: https://www.fda.gov/
AdvisoryCommittees/AboutAdvisory
Committees/ucm408555.htm.
Contact Person: Janie Kim or Denise
Royster, Center for Biologics Evaluation
and Research, Food and Drug
Administration, 10903 New Hampshire
Ave., Bldg. 71, Silver Spring, MD
20993–0002, 301–796–9016 or 240–
402–8158, email: Janie.kim@fda.hhs.gov
or Denise.royster@fda.hhs.gov, or FDA
Advisory Committee Information Line,
1–800–741–8138 (301–443–0572 in the
Washington, DC area). A notice in the
Federal Register about last minute
modifications that impact a previously
announced advisory committee meeting
E:\FR\FM\21DEN1.SGM
21DEN1
]]>Agencies
[Federal Register Volume 80, Number 244 (Monday, December 21, 2015)]
[Notices]
[Pages 79343-79345]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-32027]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1653-NC]
Medicare Program; Request for Information Regarding the Awarding
and the Administration of Medicare Administrative Contractor Contracts
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Request for information.
-----------------------------------------------------------------------
SUMMARY: This request for information solicits public comment on the
processes and procedures that we could use to leverage new legal
authorities to-- incentivize and reward exceptional Medicare
Administrative Contractor (MAC) contract performance; publish
performance information on each MAC,
[[Page 79344]]
to the extent permitted by law; and make MAC jurisdictional changes.
DATES: To be assured consideration, written or electronic comments must
be received at one of the addresses provided below, no later than 5
p.m. on February 19, 2016.
ADDRESSES: In commenting, refer to file code CMS-1653-NC. Because of
staff and resource limitations, we cannot accept comments by facsimile
(FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to https://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-1653-NC, P.O. Box 8013,
Baltimore, MD 21244-8013.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-1653-NC, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. Alternatively, you may deliver (by hand or
courier) your written comments ONLY to the following addresses: a. For
delivery in Washington, DC--Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Room 445-G, Hubert H. Humphrey
Building, 200 Independence Avenue SW., Washington, DC 20201.
(Because access to the interior of the Hubert H. Humphrey
Building is not readily available to persons without Federal
government identification, commenters are encouraged to leave their
comments in the CMS drop slots located in the main lobby of the
building. A stamp-in clock is available for persons wishing to
retain a proof of filing by stamping in and retaining an extra copy
of the comments being filed.)
b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
call telephone number (410) 786-9994 in advance to schedule your
arrival with one of our staff members.
Comments erroneously mailed to the addresses indicated as
appropriate for hand or courier delivery may be delayed and received
after the comment period.
FOR FURTHER INFORMATION CONTACT: Debra Bowman, (410) 786-4941.
Phyllis Atkins-Mackey, (410) 786-9362. Megan Martino, (215) 861-4425.
Sue Pelella, (215) 861-4245.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: https://www.regulations.gov. Follow the search instructions on that Web site to
view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
I. Background
For several decades after Medicare's inception in 1966, private
health care insurers, known as Part A Fiscal Intermediaries (FI) and
Part B carriers, processed medical claims for Medicare beneficiaries.
Section 911 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173) added section 1874A
to the Social Security Act (the Act) to require the Secretary of Health
and Human Services (the Secretary) to replace Part A FIs and Part B
carriers with Medicare Administrative Contractors (MACs). This
contracting reform was intended to improve Medicare's administrative
services to beneficiaries and health care providers through the use of
new contracting tools, including competition and performance
incentives.
Currently, we award MAC contracts through use of competitive
procedures in accordance with the Federal Acquisition Regulation (FAR).
As authorized by the MMA, we established MACs as multistate, regional
contractors responsible for administering both Medicare Part A and
Medicare Part B claims. The transition from the Part A FIs and Part B
carriers to MACs began in 2006, and the last FI and carrier contractor
operations ended by September 2013.
We rely on a network of 16 MACs to process Medicare claims,
including 12 MACs that administer both Part A and Part B claims and 4
MACs that specialize in administering Part B claims for durable medical
equipment, prosthetics, orthotics, and supplies. MACs serve as the
primary operational contact between the Medicare Fee-For-Service (FFS)
program and approximately 1.5 million health care providers and
suppliers enrolled in the program. MACs process Medicare claims, enroll
health care providers and suppliers in the Medicare program, educate
providers and suppliers on Medicare billing requirements, and answer
provider and supplier inquiries. Collectively, the MACs process nearly
4.9 million Medicare claims each business day and disburse more than
$365 billion annually in program payments.
Section 509(a) of the Medicare Access and CHIP Reauthorization Act
of 2015 (MACRA) (Pub. L. 114-10) extended the maximum length of a MAC
contract, inclusive of all option and renewal periods, from 5 years to
10 years. Section 509(c) of MACRA added a clause to section
1874A(b)(3)(A) of the Act that requires the Secretary, to the extent
possible without compromising the process for entering into and
renewing contracts with MACs, to make available to the public the
performance of each MAC with respect to such performance requirements
and measurement standards.
II. Provisions of the Request for Information
The Government Accountability Office (GAO) has recently noted that,
now that we have accomplished the major milestone of fully implementing
and transitioning to the MAC environment, we have the opportunity to
consider whether some additional contracting mechanisms could be
utilized to further improve MAC performance. Consistent with the new
authority provided under MACRA and the recommendation provided by GAO,
we are evaluating numerous elements of our MAC acquisition strategy,
including potential adjustments to our MAC contract terms and
conditions. The scope of our evaluation includes the processes and
procedures that we use for awarding the MAC contracts and administering
the MAC contracts after award.
We currently use a cost-plus-award-fee contract type for the MAC
contracts, meaning that MACs are financially incentivized and rewarded
with
[[Page 79345]]
additional fee/profit for exceptional performance in areas critical to
the success of the Medicare FFS program. For example, and specific to
provider satisfaction, we currently measure, evaluate, and reward MACs
for the quality (accuracy, completeness, customer skills, and adherence
to the Privacy Act of 1974) of their customer service representatives'
responses to provider telephone calls and the providers' level of
satisfaction with the MAC's Web site. The amount of award fee earned by
the MAC is based on our comprehensive evaluation of the MAC's
performance against specific, written quality measures and evaluation
criteria.
Prior to the enactment of MACRA, the law required that MAC
contracts be recompeted no less frequently than once every 5 years,
which created the potential for frequent turnover in these critical
contracts and disruption for Medicare providers and suppliers. With the
enactment of MACRA, we are now able to renew a MAC contract for up to
10 years and reduce the potential for frequent turnover if the MAC
meets or exceeds our performance objectives; conversely, we may still
utilize competitive procedures sooner than 10 years in the event that a
MAC does not meet our performance objectives. In concert with or in
(partial or full) replacement of our award fee process, we are
considering incorporating an ``award term'' concept into MAC
contracting, meaning that we may incentivize and reward consistently,
well-performing MACs with a longer-term contract (but not longer than
10 years). For example, MACs that consistently exceed our performance
standards may be rewarded with a longer-term contract (up to 10 years);
whereas, MACs that do not consistently exceed our performance standards
may be limited to a shorter-term contract (more or less than 5 years).
Therefore, we are soliciting public comment on the following questions
regarding MAC incentives for exceptional performance:
Do you have any concerns or suggestions related to
development of a potential ``award term'' strategy and plan?
Do you have any other suggestions for incentivizing and
rewarding exceptional MAC performance?
Are there any specific metrics or evaluation criteria that
would be valuable in measuring the level and quality of the service
provided by a MAC?
Are there any specific metrics or evaluation criteria that
would be valuable in measuring the level and quality of the MAC's
relationships (including education and outreach) with providers?
Section 509(c) of MACRA directs us to make some MAC performance
metrics available to the public, to the extent that doing so can be
done in a manner that does not compromise the competitive procurement
process. Therefore, we are requesting comment on the following
questions regarding MAC performance transparency:
With regard to the MAC's quality and level of service and
performance, what types or kinds of information should be published for
public release?
If we were to publish the results of the evaluation of a
MAC's performance on our Web site, which types of metrics or
information should be made available for public release?
We are also soliciting public comment on potential MAC
jurisdictional changes. Currently, there are 12 A/B MAC jurisdictions;
in 2010, we announced a plan to consolidate FFS claims operations to 10
A/B MAC jurisdictions over the course of several years. However, in
2014, we announced that we were postponing the consolidation of
Jurisdictions 8 (which encompasses the states of Indiana and Michigan)
and 15 (which encompasses Kentucky and Ohio) to form ``Jurisdiction I''
and the consolidation of Jurisdictions 5 (Iowa, Kansas, Missouri and
Nebraska) and 6 (Illinois, Minnesota, and Wisconsin) to form
``Jurisdiction G.'' For more information on our 2010 strategy for
consolidating A/B MAC jurisdictions, as well as our 2014 decision to
postpone the final 2 jurisdictional consolidations, see https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/RFI-Announcement-AB-MAC-March-2014.pdf
Accordingly, we are requesting comment on the following question:
What would the advantages and disadvantages be if CMS
completed the last two MAC consolidations?
III. Collection of Information Requirements
This request for information document does not impose any
information collection requirements. In accordance with the
implementing regulations of the Paperwork Reduction Act of 1995 (PRA)
at 5 CFR 1320.3(h)(4), we believe it is a general solicitation of
comments from the public. Therefore, it is exempt from the requirements
of the PRA (44 U.S.C. 3501 et seq.).
IV. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not able to acknowledge or
respond to them individually. We will consider all comments we receive
by the date and time specified in the DATES section of this preamble,
and, when we issue a subsequent document, we will respond to the
comments in the preamble to that document.
Dated: November 23, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-32027 Filed 12-18-15; 8:45 am]
BILLING CODE 4120-01-P
