Data Request Documents & Links

Use the links below to download request documents.

COBA Worksheet

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 

The DRA establishes the terms of use 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.

DRA Data Table

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.

DRA Custodian Form

The DRA Custodian Form is required to add custodians and analytic and administrative downstream users to the DRA for Medicare data requests for Medicare-Medicaid care coordination and program integrity activities.

Electronic File Transfer (EFT) Setup Form  and EFT Partner Server Questionnaire 

The EFT Setup Form and EFT Partner Server Questionnaire enables state Medicaid agencies to establish electronic feeds of Medicare data.

Information Exchange Agreement (IEA)

The 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 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.

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