Use the links below to download request documents.
- The Coordination of Benefits Agreement (COBA) Specification Worksheet
enables states to specify the intended use of COBA-acquired data.
Data Request and Attestation (DRA) Form
governing states' access to Medicare data. State Medicaid agencies
requesting data for the first time should submit the DRA form, as part of their data request
package, to MMCO directly through the State Data Resource Center and not to any other organization.
State Medicaid agencies should also use the DRA form to change the data requestor on the DRA.
- The DRA Data Table is required to add additional data and Medicare-Medicaid care coordination
and program integrity data uses to the DRA. State Medicaid agencies with an existing DRA should submit
and updated DRA Data Table with their new or additional use data request packages.
- The DRA Custodian Form is required to add custodians, analytic,
and administrative downstream users to the DRA for Medicare data
requests for Medicare-Medicaid care coordination and program integrity activities.
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 Parts A and B Worksheet
- The Historical Parts A and B worksheet is a key document in the
Historical Parts A and B data request package, enabling states to specify
which data types and variables of Medicare Parts A and 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
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.