J-19A Workload Implementation HandbookM Legacy to MAC.docx

CMS

CENTERS FOR MEDICARE & MEDICAID SERVICES

MEDICARE ADMINISTRATIVE CONTRACTOR

WORKLOAD IMPLEMENTATION HANDBOOK

MEDICARE CONTRACTOR MANAGEMENT GROUP

06/10/10

RFP- RRB-11-R-001

TABLE OF CONTENTS

Exhibits………………………………………………………………………………………….

Index ……………………………………………………………………………………………..

I MAC Workload Implementation Handbook 06/10/10

INTRODUCTION

Medicare Administrative Contractor Workload Implementation Handbook

This handbook was prepared by CMS to assist an incoming Medicare Administrative Contractor (MAC) in the transfer of claims administration functions from a Medicare carrier or intermediary whose contract is ending. The handbook represents a compilation of best practices, lessons learned, and over 25 years of CMS experience in overseeing Medicare workload transitions. It describes the basic responsibilities and processes required to move Medicare data, records, and operational activities from an outgoing carrier/intermediary so that the incoming MAC will be able to perform its Medicare contractual obligations. While both the incoming MAC and outgoing carrier/inter-mediary are responsible for accomplishing various activities during the transition, this handbook is intended for use by the incoming MAC. A similar Carrier/Intermediary Workload Closeout Handbook has been developed for the outgoing contractors.

Every Medicare workload transition will vary depending on the unique circumstances and environment of the Medicare contractors involved. There may be activities and processes described in this handbook that will not be applicable to a specific implementation. There may also be activities that will need to be performed that the handbook does not cover. It should also be noted that the handbooks are written from the perspective of a contractor leaving the Medicare program. Not all of the activities described in this handbook will be applicable to those contractors who are moving only a portion of their workload to a MAC and will continue to process other Medicare claims. The handbook cannot identify and address all of the variations that may occur during a workload transition, nor all of the tasks for which the incoming MAC will be responsible. However, it will provide the framework for a successful workload implementation and guidance in addressing situations as they arise.

This June 10, 2010 version of the MAC Workload Implementation Handbook is comprised of 14 chapters, 10 exhibits, and an index. It supersedes all other versions.

Chapters

1. Chapter 1: Introduction provides an introduction to the Handbook and the goals for a successful workload transition.

2. Chapter 2: CMS Organization provides information on the duties and responsibilities of CMS’s transition oversight staff.

3. Chapter 3: Getting Started describes the activities that are necessary to start the implementation process. It discusses establishment of the implementation team, kickoff meetings, and the organization and function of transition workgroups. The chapter also addresses initial notification activities.

Exhibits Exhibit 1 Transition Phases and Terminology

Exhibit 2 MAC Contract Administrative Structure

Exhibit 3 Major Tasks and Activities Associated with a Workload Transition

Exhibit 4 Outgoing Contractor Information/Documentation

Exhibit 5 Files to be Transferred to a Medicare Administrative Contractor

Exhibit 6 Sample Post-Cutover Workload Report

Exhibit 7 MAC Workload Implementation Meeting and Documentation Guide

Exhibit 8 Workload Transition Lessons Learned

Exhibit 9 Glossary

Exhibit 10 Acronyms

Index Transition Phases

While there are multiple parties involved in a Medicare workload transition, there are three major participants: the incoming contractor (MAC), the outgoing contractor (carrier or intermediary) and CMS. Each transition has three phases. For a MAC, the three phases of a Medicare workload transition are identified as: pre-award, implementation, and post-cutover.

The pre-award phase is comprised of the activities associated with preparing and submitting a MAC proposal. The implementation phase covers the activities associated with establishing a MAC operation and the transfer of data, records, and functions from the various carriers and intermediaries within its jurisdiction. It begins with the award of a MAC contract and ends with the last cutover from an outgoing contractor or segment. The post-cutover phase begins with the segment operational start date and continues for a period of time, usually three months. During this time CMS closely monitors MAC operations to determine if the segment implementation was successful and to ensure that all implementation issues have been resolved.

This handbook provides information that will assist the MAC in all three phases of the transition. However, its primary focus is on the implementation and post-cutover phases of the incoming contractor. Exhibit 1 provides a graphic representation of terminology for the major transition participants.

Segment Implementations

The establishment of a fully operational MAC jurisdiction will involve segment implementations, the number of which will depend on the number of Medicare carriers and intermediaries that are serving the states within the jurisdiction. Each segment implementation involves the movement of Medicare data, files, and functions from an existing Medicare carrier or intermediary to the MAC. Workload implementation periods have ranged from 3-8 months, depending on the size of the outgoing contractor and numerous other factors. Most implementations, however, are 5-6 months in length. The length and sequence of individual segment implementations must be developed using the requirements and assumptions provided in the MAC Request for Proposals (RFP) and resultant contract. The duration and sequence of the segment implementations must be incorporated into the MAC’s Jurisdiction Implementation Project Plan, which will be approved by CMS.

The MAC will begin to perform Medicare functions as soon as the first segment cutover has occurred. This will be the Segment Operational Start Date. As each segment cutover in the MAC jurisdiction occurs, there will be another Segment Operational Start Date and the MAC’s Medicare administrative responsibilities will expand over a wider area of its jurisdiction until it is fully operational in all states within its jurisdiction. This will be the Jurisdiction Operational Start Date, which is defined as the date when Medicare functions are no longer performed by any carrier or intermediary whose workload the MAC contractually assumed.

Terminology

For purposes of this handbook, the Medicare Administrative Contractor who will be assuming the Medicare functions of the outgoing carrier or intermediary is referred to as the “incoming contractor.” Both “MAC” and “incoming contractor” are used interchangeably.

The term “outgoing contractor” refers to a carrier or fiscal intermediary (or simply intermediary) that is performing Medicare claims processing functions under a Part A Plan subcontract agreement with the Blue Cross and Blue Shield Association (BCBSA) or a Part B contract. These contractors are also known as “legacy contractors.” The terms “outgoing contractor”, “carrier/intermediary”, and “legacy contractor” are used interchangeably throughout this handbook. Legacy contractors may also be referred to as “Title XVIII contractors,” but this term should be avoided because the MAC contracts are also entered into under Title XVIII of the Social Security Act.

A “transition” is defined as the period of time that encompasses the movement of Medicare operations from a carrier/intermediary to a MAC. The term “implementation” is used for those activities performed by the incoming MAC during a transition. The term “closeout” is used for those activities performed by the outgoing carrier/ intermediary. However, in general usage, the term “transition” will often be applied to the incoming MAC’s “implementation” and outgoing carrier/intermediary’s “closeout” activities.

The term “provider” is used in the broad sense of the word, meaning anyone providing a Medicare service; i.e., institutional provider (hospital, skilled nursing facility, rural health clinic, federally qualified health center, or home health agency), physician, non-physician practitioner, or supplier.

The term “biweekly” means every two weeks.

Goals of a Successful Workload Transition

All of the organizations involved in a workload transition have a responsibility to ensure that the transition is conducted properly and that their contractual obligations are met. While each component has different roles and responsibilities during a transition, the goals remain the same:

· There is minimal disruption to beneficiaries;

· There is minimal disruption to providers, physicians and suppliers;

· There is no disruption of claims processing and Medicare operations;

· The transition is completed on schedule within the required time period;

· Actual costs represent effective and efficient use of resources; and,

· All parties with an interest in the transition (whether direct or indirect) are kept informed of the transition’s status and progress.

In order to accomplish these goals, there must be proper project planning and management by the Medicare Administrative Contractor, maintenance of existing Medicare operations by the outgoing carrier or intermediary, and comprehensive oversight by CMS. All parties involved in the transition must cooperate fully and communicate constantly with all other parties at every level. This handbook will help the incoming MAC achieve the abovementioned transition goals and meet its contractual obligations during the implementation period of performance.

Chapter 1: Introduction

CMS ORGANIZATION

There will be a number of CMS staff responsible for overseeing the implementation activities of the MAC and the closeout activities of the carrier/intermediary. Listed below are the individuals who will monitor MAC implementation activities, along with a description of their responsibilities. Also discussed are the individuals who will be responsible for the closeout activities of the outgoing carrier/intermediary’s legacy contract.

CMS Contract Administration Personnel – MAC Contracts

The following individuals will be responsible for monitoring the implementation and/or operational activities of the Medicare Administrative Contractor. They will also interact with the carrier/intermediary in various meetings and workgroups. A CMS administrative organizational chart for the MAC contracts is shown in Exhibit 2.

MAC Contracting Officer The MAC Contracting Officer (CO) has the overall responsibility for the Medicare Administrative Contractor and is the only person authorized to enter into and bind the government by contract. He/she is the individual that negotiates and prepares the MAC contract document, modifies any terms or conditions of the contract, accepts delivered services, and approves invoices for payment. While a single person could serve as both the carrier/intermediary CO and the MAC Contracting Officer, in the present CMS organizational structure they are two different individuals.

MAC Project Officer The MAC Project Officer (PO) serves as the first point of contact for the MACs. He/she is the focal point for the exchange of information and the receipt of programmatic approvals on deliverables and other work under the MAC contract. The PO is the technical representative of the MAC Contracting Officer and provides technical direction to the MAC, as necessary, for all of the business functions contained in the MAC statement of work. He/she also monitors the contract performance of the MAC and reviews payment invoices. The PO may designate various business function leads and technical monitors to support the administration of the MAC contract. The Project Officer position is also known as the Contracting Officer’s Technical Representative (COTR).

MAC Implementation Lead The MAC Implementation Lead (IL) will be the PO’s representative for the overall MAC jurisdiction implementation and will serve in a specialized technical capacity to the Project Officer. The Implementation Lead will manage CMS’s oversight of the jurisdiction transition and coordinate MAC implementation activities with the carrier/intermediary Contractor Managers and the functional contractor Project Officers. He/she will also resolve issues involving the various segment transitions within the jurisdiction.

The Implementation Lead, as a representative of the Project Officer, will provide technical guidance and direction to the MAC. The IL will also work with the Medicare Implementation Support Contractor (MISC) to oversee the segment implementations within the jurisdiction.

The Implementation Lead will work with business function leads (BFLs) concerning implementation issues. He/she will also coordinate implementation activities with the Project Officers of the functional contractors involved in the MAC implementation. The IL will conduct problem solving/trouble shooting during the implementation and be responsible for reporting to senior management. In addition, the Implementation Lead will review invoices for jurisdiction implementation activities and provide recommendations to the Project Officer.

Medicare Implementation Support Contractor Because of the number of implementations and the limited staff available for oversight, CMS has entered into a contract with Chickasaw Nation Industries (CNI) for a Medicare Implementation Support Contractor (MISC). The MISC will provide the project management support and the oversight services needed by CMS to monitor the implementation activities of the MACs and functional contractors. The contractor will be providing these oversight activities for each segment within a jurisdiction.

There will be a MISC business analyst (BA) assigned to each jurisdiction. The business analyst’s primary responsibility will be the segment implementations. The Medicare Implementation Support Contractor will have direct access and interaction with the MAC and outgoing contractor staff involved in the implementation. The BA will be a member of transition workgroups and attend all meetings associated with those workgroups. He/she will also attend general jurisdiction status meetings and teleconferences. The BA will work closely with the Implementation Lead and will be the point person for segment implementation activities.

The MISC will share comments, concerns and recommendations directly with the MAC when appropriate. However, the MISC does not have authority to provide technical direction to the MAC.

The MISC Government Task Leader (GTL) will be primarily responsible for managing the MISC task order under the CNI contract. The GTL represents the Project Officer for the technical aspects of the Medicare implementation support activities under the CNI contract and may provide technical direction under the auspices of the PO. The GTL will interact with the Implementation Lead throughout the implementation to obtain information on the MISC’s performance and resolve any issues that may occur.

Business Function Lead Business Function Leads (BFLs) may be called upon to assist the Project Officer in the administration of the MAC contracts. They are normally located in CMS Central Office. Business Function Leads will assist the Project Officer on an as needed basis and will act as a technical representative for their specific business function. BFLs may monitor technical progress and perform technical evaluations and inspections. They may also assist the PO with specific functional inquires and technical issues. In addition, they will review monthly invoices pertaining to their area and make payment recommendations to the PO. However, BFLs do not have the authority to provide technical direction or make any contractual commitments or changes on behalf of CMS.

Technical Monitor Technical Monitors (TMs) are Regional Office personnel who may provide information on contractor performance and help the Project Officer resolve issues, particularly those from beneficiaries and providers. The TM may assist the BFL in performing technical evaluations and inspections and may also provide input to monthly and quarterly contract administration meetings. In addition, Technical Monitors may perform on-site validations of accounts receivables and debts.

CMS Contract Administration Personnel - Carrier/Intermediary Contracts

The following are the key CMS individuals (along with the above-mentioned Implementation Lead) that the carrier/intermediary will interact with regarding the activities related to the closeout of its Medicare operations and transfer of data, records and files to the incoming Medicare Administrative Contractor.

Carrier/Intermediary Contracting Officer The carrier/intermediary Contracting Officer has the administrative responsibility for the outgoing contractor’s Title XVIII Medicare contract. The carrier/intermediary Contracting Officer has overall responsibility for the carrier/intermediary’s closeout activities and negotiating termination and transition costs.

Contractor Manager

Chapter 2: CMS Organization The Contractor Manager is the CMS individual responsible for monitoring the day-to-day operational activities of the outgoing legacy contractor. He/she will be responsible for ensuring that the carrier/intermediary continues to maintain its overall operation and performance during the closeout period. The Contractor Manager will work closely with the Implementation Lead to ensure that the carrier/intermediary cooperates with the MAC during the transition and that all Medicare files, records, and data are successfully transferred to the incoming Medicare Administrative Contractor.

GETTING STARTED

Contract Award

The MAC Contracting Officer will place a call to inform the successful offeror of its MAC contract award. This will start the implementation phase of the transition. Unsuccessful offerors will also be notified and CMS will issue a press release. The MAC may also want to issue its own press release; if so, CMS will provide input and review the content prior to release.

Initial Transition Activities

The MAC’s implementation team will be composed of a Project Manager and staff who are responsible for the major implementation tasks shown in the Jurisdiction and Segment Implementation Project Plans (see Chapter 4.3). A team member will usually be assigned to be the lead for each major implementation task or workgroup and will report directly to the Project Manager.

An internal meeting with all key MAC implementation members (project manager, business analysts, potential workgroup leaders, and subject matter experts) should be held after contract award to plan and prepare for the upcoming project and to handle administrative details. The project organization and workgroup structure may need to be revised and/or expanded. A final organization chart and contact list should be developed in preparation for the kickoff meeting. There may also be additional transition tasks or CMS-directed schedule date changes that are identified, and the MAC should begin to baseline the Jurisdiction Implementation Project Plan. Tools to assist the team in managing the project can be identified and discussed. Team training in project management, financial tracking (data, cost analysis), and administration (software applications, reports, general project communication) may be helpful. Internal procedures for meetings and communications should be agreed upon.

The outgoing carriers/intermediaries will form closeout teams composed of a Project Manager and staff responsible for contract closeout activities. The outgoing contractors’ closeout teams shall work directly with the MAC for the orderly transfer of all Medicare functions. Information regarding the outgoing contractors’ closeout teams will be provided at the kickoff meeting.

Contact with Outgoing Contractor

After CMS has publicly announced the contract award and implementation schedule, the MAC may contact the outgoing contractors in the jurisdiction. Contact is usually made by upper management, and will serve as an introduction to the MAC. Areas of discussion may include the outgoing contractor’s plans for its Medicare employees, any proposed retention of staff by the incoming MAC, communication, commitment of the organizations, any schedule date changes that may have occurred after the RFP was issued, and any immediate problems or issues that need to be addressed before the kickoff meeting. The MAC may also make introductory calls to the major professional organizations (medical societies, hospital associations, specialty groups, etc.) within the jurisdiction, with follow-up calls as each segment implementation begins. The MAC may also want to make contact with the various state Congressional delegations.

In the days immediately following the award announcement, the MAC must understand that it may be difficult to have extensive contact with certain outgoing contractors because they may still be trying to deal with the loss of the jurisdiction contract. Those contractors may be assessing their options, addressing employee concerns, or preparing to protest the award. It is also possible that the outgoing contractor is only losing a portion of its workload and may be competing against the incoming MAC for future jurisdictions. All of this may result in little information initially being provided to the MAC.

The incoming MAC must take these possibilities into account when it initiates contact with the outgoing contractor and be cognizant of the outgoing contractor’s situation when communicating and requesting information. If the outgoing contractor has already indicated that it is leaving the Medicare program, general communication should not be an issue.

Outgoing Contractor Employee Notification

After award announcement, the carriers and intermediaries who were not awarded the contract will begin to plan for their contract closeout. If the MAC has an interest in hiring any of the outgoing contractor’s Medicare employees, it should inquire about the carrier/intermediary’s plans for those employees. If the outgoing contractor will not be retaining its Medicare staff, the MAC should inform the carrier/intermediary that it may be interested in making employment offers to some or all of its employees. Plans should be coordinated with the carrier/intermediary to notify the employees affected and a face-to-face meeting should be scheduled as soon as possible. Commitment of the outgoing contractor’s employees is critical to the success of any transition. Obviously, knowledge that jobs will be retained will greatly facilitate the transition process and alleviate fears regarding employees’ futures.

If the MAC will be hiring a significant number of outgoing contractor staff, a human resources representative from the MAC may be able to be located at the carrier/ intermediary’s site to address employee concerns and provide detailed information about employment and benefits. An analysis of the outgoing contractor’s employee benefits will need to be done as soon as possible, and an explanation of the differences between the two organizations’ benefits should be available to outgoing contractor staff. Meetings should be scheduled with staff to be hired to discuss differences in benefits and provide information on what will occur at cutover. The MAC may also be able to contribute transition-related articles to the outgoing contractor's employee newsletter.

Jurisdiction Kickoff

Jurisdiction kickoff is normally composed of 3-5 separate meetings that may be conducted over a several day period. Jurisdiction kickoff is intended for all parties involved in any of the segment transitions that will occur within the jurisdiction, but not all parties will attend every meeting. There will be a minimum of three meetings held at kickoff: the MAC pre-meeting, the outgoing contractor pre-meeting, and the general jurisdiction kickoff meeting. Kickoff may also include a segment kickoff meeting if a segment implementation is scheduled to begin at contract award. In addition, the post-award orientation conference that is conducted by the MAC Contracting Officer may be held as part of the kickoff, if the conference has not already been held.

Jurisdiction kickoff is generally held within 30 days of contract award. The meetings will be held in the Baltimore, Maryland metropolitan area, unless CMS determines another location would be more appropriate. The MAC will be responsible for providing facilities for all of the jurisdiction kickoff meetings that will take place, providing toll-free phone lines for off-site participants, developing an agenda (with input from other participants), and notifying potential attendees. In the unlikely event that the kickoff would be held at a CMS facility, then CMS would be responsible for making facility and teleconferencing arrangements. Meeting minutes and an attendance sheet/contact list shall be prepared by the MAC and sent to all those in attendance.

Normally, each of the kickoff meetings can be completed in a half day (3-4 hours of concentrated meeting time). The exception would be the post-award orientation conference, which generally takes 1-2 hours. In-person attendance at each of the meetings will vary, depending on a number of factors. However, the general jurisdiction kickoff meeting will draw the largest number of attendees (generally 40-50). The MAC should have a meeting room with tables that will accommodate the jurisdiction meeting and several smaller rooms would be beneficial should there be the need for any smaller conferences or workgroup breakout sessions. The Implementation Lead will work with the MAC in preparation for the kickoff activities.

MAC Pre-Meeting Purpose

The MAC pre-meeting is a meeting conducted by CMS and the Medicare Implementation Support Contractor (MISC) with the incoming Medicare Administrative Contractor. It deals with information that pertains exclusively or primarily to the incoming contractor and will be held before the jurisdiction kickoff meeting. The meeting will discuss issues that have arisen since contract award, review CMS’s expectations and administrative requirements for the project, and make final preparations for the conduct of the jurisdiction kickoff meeting.

Topics of Discussion

Topics for discussion will include:

· Introduction of the CMS implementation team & contract administration structure;

· CMS project monitoring: reporting requirements, meetings, and contract deliverables;

· Introduction of the Medicare Implementation Support Contractor and discussion of its role in the project;

· Revision of Jurisdiction/Segment Implementation Project Plans (if the award has been delayed) and review of segment implementation schedules/cutover dates;

· Agreement on the key assumptions made in the MAC’s proposal;

· Workgroup discussions: number of workgroups, meeting times, toll-free numbers;

· Deliverables lists for outgoing contractors;

· New jurisdiction workload numbers (including the number of workloads in each CICS region to be identified and confirmed with CWF);

· Due diligence/on-site visits;

· Workload splits (if applicable);

· Lessons learned from previous MAC implementations;

· Discussion of MAC’s agenda and presentation for the jurisdiction kickoff meeting;

· Areas of immediate focus such as communications/provider relations, file transfer and storage, new EFT form CMS-588, Change Requests since proposal submission, and SOW changes; and

The incoming MAC will have submitted its proposal using the implementation schedule provided in the Request for Proposal (RFP). It is possible that CMS may direct the MAC to revise its overall jurisdiction plan based on schedule changes or other considerations. Should this be necessary, CMS will negotiate with the MAC to reach agreement on a revised schedule and any additional costs associated with the changes. The contract will be modified accordingly.

Outgoing Contractor Pre-Meeting This meeting is conducted by CMS with the outgoing contractor. Since these contractors will be present for the jurisdiction kickoff meeting, it provides an opportunity for CMS to discuss issues of importance solely related to contractors who are leaving the program or losing a portion of their workload. The outgoing contractor pre-meeting may be scheduled before or after the MAC pre-meeting, but generally it is held concurrently. The pre-meeting may be a joint meeting with all outgoing contractors or separate meetings with each contractor. Topics will include closeout financial issues, reporting, staffing and workload issues, accounts receivable review, and file storage/transfer.

Jurisdiction Kickoff Meeting While other meetings during kickoff will have limited audiences, the jurisdiction kickoff meeting is intended for all parties involved in any of the segment transitions that will occur. This meeting is sometimes referred to as the general kickoff meeting.

Purpose

The purpose of the jurisdiction kickoff meeting is to understand, organize, and coordinate activities among all parties involved in the transition. It provides the opportunity to meet face-to-face to discuss the approach to the MAC jurisdiction transition, go over the schedule, review roles and responsibilities, and address any concerns about the upcoming segment transitions. While there may be some detailed technical discussion, the meeting is not intended to be at the level that would require all of the functional and technical leads that the MAC may be utilizing in its implementation effort; those individuals would be expected to attend the segment kickoff meeting. Attendance would normally include the MAC’s operational and implementation project directors and a limited number of implementation project team members, such as the IT lead.

Participants

All parties directly involved in the jurisdiction transition should be invited to attend. This includes CMS, the MISC, appropriate MAC personnel, the outgoing carriers and intermediaries, the Blue Cross and Blue Shield Association (for fiscal intermediaries with Plan agreements), applicable data centers, any front-end contractors, any organization(s) that will be moving Medicare workload to the MAC during the transition or will process some portion of the outgoing contractors’ workload, shared system maintainers, and functional contractors such as the Program Safeguard Contractor (PSC), Qualified Independent Contractor (QIC), and the Beneficiary Call Center (BCC). Attendance may be in person or via teleconference. CMS will work with the MAC to develop the list of individuals/organizations that should be invited to the meeting.

Topics of Discussion

The jurisdiction kickoff meeting will give a high level overview of the transition project. The MAC will be requested to make a corporate introduction and describe its Medicare organization and operation. The MAC should also discuss its implementation team/ organization, its implementation approach, and provide an overview of its Jurisdiction Implementation Project Plan (see Chapter 4.3.1). Much of the information presented will normally be drawn from the MAC’s proposal or any oral presentations supporting the proposal. Other entities involved in the project may also be asked to provide an overview of their transition activities and interactions with the MAC. In addition, CMS will discuss its implementation expectations, review reporting and meeting requirements, and present its transition team organization.

The MAC’s due diligence review will be discussed, along with deliverables that are being requested from the outgoing contractors. Proprietary issues regarding the MAC’s interaction with the outgoing contractors will also be discussed. Any Deliverables List, action item list, or problem/issue log that is developed as a result of the kickoff meeting should be distributed as soon as possible after the meeting. The Deliverables List will serve as documentation for all the information the outgoing contractors need to provide to the MAC (see Chapter 4.12). The coordination of communication activities will also be discussed.

Transition workgroups will be a key topic of discussion at the meeting (see Chapter 3.6). The MAC will be expected to work with the outgoing contractors and other attendees to establish jurisdiction-wide transition workgroups and agree on their basic responsibilities. These jurisdiction-wide workgroups and their functions should be in place for the entire jurisdiction implementation. However, in a number of transitions, some or all of the workgroups and their remaining activities have been consolidated into the cutover workgroup when the cutover period gets underway. This expanded cutover workgroup then addresses all remaining issues and tasks as the workgroup coordinates the remaining cutover activities.

All outgoing contractors involved in the transition will have to structure their closeout activities utilizing the workgroups. Therefore, it is critical that agreement be reached with all of the outgoing contractors as to what workgroups will be established and the major responsibilities for each group. The MAC should request a workgroup contact list (name, telephone number, e-mail address, office location, etc.) from the outgoing contractor and any other organization that will have membership in a transition workgroup.

After the jurisdiction kickoff meeting is completed, the MAC should review the project schedule and the Jurisdiction Implementation Project Plan (JIPP), as well as the upcoming Segment Implementation Project Plans, risk management plans, and communications plans to make any appropriate revisions based on the discussions that took place during the meeting.

Segment Kickoff Meeting The segment kickoff meeting may or may not be a part of the jurisdiction kickoff. If it is, it will represent the formal start of the process of moving Medicare data, records, and operations from an outgoing carrier or intermediary to the MAC. It will be similar to the Jurisdiction Kickoff Meeting in concept, but will be focused on the detailed technical and functional activities required for a specific segment transition.

Purpose

The segment kickoff meeting allows all parties involved in a segment transition to meet face-to-face to review the project expectations, discuss roles and responsibilities, and to organize and coordinate activities. The meeting will also help ensure that there is agreement among all participants regarding the tasks involved, project assumptions, and schedule. In addition, any emerging issues and/or changes that have occurred since contract award will be discussed, as will any lessons learned from prior segment transitions within the jurisdiction or other jurisdictions. Organizations that cannot attend in person may do so by teleconference.

Preparation

The MAC will be responsible for setting up the kickoff meeting for each segment implementation within its jurisdiction and shall consult with CMS regarding the time and location of such meetings. The meetings will generally be held at the proposed operational site or the corporate headquarters of the MAC. Segment kickoffs may also be conducted via teleconference.

The first segment kickoff meeting(s) normally will be held as part of the jurisdiction kickoff, but there may be circumstances that dictate that the meeting(s) be held at a later time. The kickoff meetings for segments that will begin after the first round of segment kickoff meetings should take place within 10-15 days of the scheduled start date of that segment implementation. For segment kickoff meetings not occurring during jurisdiction kickoff, the MAC should meet with the CMS transition team prior to the meeting to discuss the agenda, materials to be handed out, and presentations that will be made.

All MACs will have to conduct multiple segment implementations in order to become fully operational. It is possible that there will be more than one segment implementation starting in the same month. If this occurs, the MAC will need to coordinate the scheduling of the kickoff meetings with CMS and the outgoing contractors of the segments. Normally, each segment implementation will require its own kickoff meeting; however, it is possible that the integration of segments in the project plan would allow for one kickoff meeting to cover multiple segment implementations. If there is HIGLAS involvement in the segment, there will normally be a HIGLAS kickoff meeting that will occur relatively close to the segment kickoff meeting.

The MAC will be responsible for setting up the facilities for the segment kickoff meeting, providing toll-free phone lines for off-site participants, developing an agenda (with CMS input), and notifying attendees. Meeting minutes and an attendance/contact list shall be prepared by the MAC and sent to all those in attendance.

Participants

All parties directly involved in the segment transition should be invited to attend: CMS (including the MISC), appropriate technical and operational MAC personnel, the outgoing segment contractor, any organization other than the MAC that will be responsible for processing a portion of the outgoing contractor’s Medicare workload, representatives from the applicable data center(s), shared system maintainers, the Blue Cross and Blue Shield Association (for fiscal intermediaries with Plan agreements), any front-end contractor, IT services companies, and functional contractors (e.g., PSC, QIC, BCC). Attendance may be in person or via teleconference. All of the key members of the MAC’s segment implementation team should be in attendance as well as most, if not all, of the anticipated workgroup heads.

Since detailed information and operational procedures may be discussed, attendance at the segment kickoff meetings should include more technical and functional experts than necessarily would be in attendance at the jurisdiction kickoff meeting. The MAC must have representatives present with the authority to establish project commitments and approvals on behalf of the organization.

Topics of Discussion

The MAC will be requested to make a corporate introduction, describe its Medicare organization, and discuss its implementation team and structure. This presentation would be similar to the one made at the Jurisdiction Kickoff Meeting, but geared to the specific segment implementation. The Segment Implementation Project Plan (SIPP) should be distributed (see Chapter 4.3.2) and an overview of the plan and the MAC’s implementation approach provided. Input from attendees will be used by the MAC to prepare the “baseline” SIPP that will be submitted to CMS within 30 days of the meeting. The outgoing contractor will make a presentation regarding its organization, closeout plan, and project team. The carrier/intermediary should also discuss any pilot projects, unique working relationships or workloads, and situations where there are processing regions and files containing commingled data for states in multiple jurisdictions. Other involved parties will provide an overview of their activities and participation in the transition. CMS will discuss its transition organization and team and review reporting requirements (see Chapter 11).