SDRC

State Data
Resource Center

Resources for States Integrating Medicare and Medicaid Data

Use the links below to download request documents and access request-related websites.

COBA Worksheet
The Coordination of Benefits Agreement (COBA) Specification Worksheet enables states to specify the intended use of COBA-acquired data.

Data Use Agreement (DUA) Forms
The Data Use Agreement (DUA) establishes the terms of use governing states' access to Medicare data.
On the website for CMS DUAs (linked above), there are a number of DUA forms available to site visitors. With requests for Medicare data facilitated by the State Data Resource Center, State Medicaid Agencies only need the new, additional data use, update, and addendum versions of these forms. In addition, State Medicaid Agencies should submit an appropriate DUA form, as part of their data request package, to MMCO directly through the State Data Resource Center and not to any other organization.

DUA Addendum
The Data Use Agreement (DUA) Addendum is required to add analytic and administrative downstream users to the DUA for Medicare data requests for Medicare-Medicaid care coordination and program integrity activities.

DUA Attachment A
The Data Use Agreement (DUA) Attachment A supplements CMS DUA forms for downstream users that are providers, specifying data terms of use specific to Medicare data requests for Medicare-Medicaid care coordination.

Electronic File Transfer (EFT) Setup Form and EFT Partner Server Questionnaire
The Electronic File Transfer (EFT) Setup Form and EFT Partner Server Questionnaire enables State Medicaid Agencies to establish electronic feeds of Medicare data.

Information Exchange Agreement (IEA)
The Information Exchange Agreement (IEA) establishes the terms governing states' access to Medicare data for the purpose of Medicare-Medicaid care coordination or program integrity.

Historical A/B Worksheet
The Historical A/B worksheet is a key document in the Historical A/B data request package, enabling states to specify which data types and variables of Medicare Parts A & B data are needed and how they will be used. This worksheet includes additional tabs for assessments data. These tabs enable states to specify which variables from MDS, OASIS, Swing Bed, and IRF-PAI assessments are needed as part of an Assessments data request package.

Part D Worksheet
The Part D worksheet is a key document in the Part D data request package, enabling states to specify which data types and variables of Medicare Parts D data are needed.