In 2011, the Centers for Medicare & Medicaid Services (CMS) developed the State Data Resource Center (SDRC) to provide Medicaid agencies with support, assistance, and guidance on how to request, access, and use available Medicare data to support people who are dually enrolled in both Medicare and Medicaid, also known as dually eligible individuals. The SDRC Support Team consists of data experts who provide Medicaid agencies with information and resources to help support their use of Medicare data for Medicare-Medicaid care coordination, program integrity, and quality improvement purposes.
Through the SDRC project, state and territory requestors have access to technical advisers who can:
These technical advisors are provided by Dobson | DaVanzo & Associates, LLC and Acumen, LLC.
Medicare-Medicaid Coordination Office
The CMS Medicare-Medicaid Coordination Office (MMCO) serves people who are dually eligible for Medicare and Medicaid. MMCO’s goal is to ensure that these dually eligible individuals have full access to seamless, high-quality health care and to make the system as cost-effective as possible.
MMCO works with the Medicaid and Medicare programs, federal agencies, Medicaid agencies, and stakeholders to align and coordinate benefits between the two programs effectively and efficiently. MMCO also partners with states and territories to develop new care models and improve the ways that dually eligible beneficiaries receive healthcare.
Center for Program Integrity
The CMS Center for Program Integrity’s (CPI) mission is to detect and combat fraud, waste, and abuse of the Medicare and Medicaid programs. CPI does this by making sure CMS is paying the right provider the right amount for services covered under our programs. CPI works with providers, states, territories, and other stakeholders to support proper enrollment and accurate billing practices.
Ten Opportunities Highlighted in the CMS State Medicaid Director Letter (SMDL) #18-012
CMS released SMDL #18-012 highlighting 10 opportunities for Medicaid agencies to better serve dually eligible beneficiaries for Medicare and Medicaid.
December 19, 2018
Read the LetterOpportunities to Serve Better
The opportunities outlined in this letter, which do not require complex demonstrations or Medicare waivers, can be grouped into three broad areas:
Integrating care through managed care arrangements.
Using Medicare data to inform care coordination and program integrity initiatives.
Reducing administrative burden for dually eligible beneficiaries and the providers who serve them.
SDRC can assist Medicaid agencies with Opportunity 5 and 6 related to using Medicare data, and SDRC can provide valuable resources supporting Opportunities 7 and 8 related to frequency of MMA File and State Buy-in File data exchanges.
CENTERS FOR MEDICARE & MEDICAID SERVICES
Baltimore, MD
The Centers for Medicare & Medicaid Services (CMS) is a federal agency in the U.S. Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
DOBSON DAVANZO & ASSOCIATES, LLC
Vienna, VA
Dobson | DaVanzo & Associates, LLC is a health economics and policy consulting firm with longstanding experience in working with both publicly-available and proprietary claims and financial datasets. The firm has worked with CMS on multiple contracts for over a decade. The work of our principals has influenced many public policy decisions and appears in numerous instances in legislation and regulation. Our research helps payers and providers develop, implement, and evaluate equitable payment methodologies. Applying decades of experience and innovative research techniques, our rigorous and objective analyses make use of a variety of public and private-sector data sources.
ACUMEN, LLC
Burlingame, CA
Acumen, LLC conducts policy research in support of federal, state, and local health care and social policy programs. We leverage our vast data resources to improve information available to policymakers on topics such as drug and vaccine safety; health insurance markets; value-based purchasing; and health care fraud.
For the State Data Resource Center (SDRC) project, Dobson | DaVanzo & Associates, LLC and Acumen, LLC work closely with CMS to help states learn about Medicare data, their formats, and their limitations. To this end, the SDRC Team offers state Medicaid agencies:
Support requesting certain Medicare data, including eligibility and enrollment data, Medicare Parts A and B claims and Part D event data, and assessments data including MDS, OASIS, Swing Bed, and IRF-PAI.
Assistance understanding the formats and idiosyncrasies of Medicare data.
Periodic webinars on various aspects of the State Data Resource project—from the type of data to request to methods of linking Medicare and Medicaid databases.
To learn more about these support services, contact the SDRC Team by phone at (888) 805-5228 or email.
Coordinating Care For Dually Eligible Beneficiaries
Additional information on coordinating care for dually eligible beneficiaries can be found on the About Care Coordination for Dually Eligible Beneficiaries page.
Go to Care CoordinationCMS Support Of State Program Integrity Activities
More information about CMS support of state program integrity activities can be found on the About Program Integrity page.
Go to Program Integrity
The State Data Resource Center (SDRC) website was established to facilitate state access to, and use of, Medicare data for Medicare-Medicaid care coordination and program integrity.
Attention
You are leaving the SDRC Public website and are being redirected to the new SDRC Portal website, where you can submit and track data requests, ask questions, and access SDRC resources. You will need a username and password to log into the SDRC Portal. If you are Medicaid agency staff and/or associated downstream user who would like access, please contact the SDRC Support Team for more information.
