It looks like none of the non-MolDx MACs could successfully take on Jurisdiction E, which is being re-bid right now, and take it out of the MolDx policy system. Reasoning follows.
Jurisdiction E (California, Hawaii, Nevada) Is Up For Re-Bid
Jurisdiction E, one of the largest MACs, especially from the perspective of molecular testing, is up for re-bid.
The federal Request for Proposals (RFP) for Jurisdiction E posted on August 20, 2019, with responses due November 4, 2019. See website here, solicitation number 75FCMC19R0023. The anticipated award date for the new contract was posted as August 4, 2020.
(Click through the documents at the bottom of that webpage, 5 at a time, to see the most interesting document, the 150 page statement of work. On my PC, I had to rename as a PDF-type file to open it.)See my cloud copy of the statement of work here.
Pp. 47-50 describe the medical director duties; there should be 3 FTE medical directors for this MAC.
CMS Caps Contractor at 26% of Workload; Contractor Group at 40%
In 2017/2018, the NGS MAC protested the limit on total share of MAC workload that can be held by any one MAC. It lost. Here. According to the case, CMS caps workload of any one corporate entity to 26% of national MAC workload, and a group of companies shall not hold more than 40% of MAC workload. My understanding is that Palmetto + CGS are a group of companies; and Novitas + FCSO are a group of companies.
Do The Math
Using a table included in the GAO case, I've rearranged the contractors by group.
There are three non-MolDx contractors, NGS MAC, FCSO, and Novitas. Here's my math. FCSO can win California, which has 9.1% of CMS workload, but then the FCSO+Novitas group will have 32%+9% = 41% of CMS workload, more than 40%. So FCSO can't win California, I don't think.
Novitas can't win California, because it already has 25% of CMS workload, basically at its 26% limit.
NGS MAC has 20% of CMS workload, so it can't add 9.1% for California, which would give it 29%, over the 26% limit. However, NGS MAC could spin off into two shell companies under one parent company, and then either NGS MAC company (with 7.8% and 12% respectively) could add the 9% JE MAC.
So, taking this as a sort of puzzle, the only way I see that a non-MolDx MAC could win JE is by NGS MAC splitting into two companies (possibly under a parent company, something discussed in the GAO legal case cited) in which case it could win JE. If that happen, JE might become a non-MolDx MAC. Check back in August 2020 for the result.
See the MolDx federal "Statement of Work" here.