Since 2005, state Medicaid agencies have been submitting files at least monthly to CMS to identify all people who are dually enrolled in both Medicare and Medicaid, also known as dual-eligible beneficiaries. This includes both full-benefit dual-eligible individuals and partial-benefit dual-eligible individuals (e.g., those who only receive Medicaid help with Medicare premiums or cost-sharing). The file that states submit is called the MMA File (after the Medicare Prescription Drug Improvement and Modernization Act of 2003) or State Phasedown File.
The MMA File Exchange is the state data exchange that provides current information on updated full- and partial-benefit dual-eligible beneficiary status. The state sends its MMA File to the CMS Medicare Beneficiary Database (MBD), and for each “request file” received from the state, the CMS MBD generates an MMA Response File for the state. While states are required to exchange data monthly, they can exchange it as frequently as daily.
The Information Exchange Agreement (IEA) between CMS and the state Medicaid agency covers the MMA File Exchange. For more information about the IEA and accompanying Data Request and Attestation (DRA) form, please visit the Data Sharing Agreement page.
The Medicare-Medicaid Coordination Office (MMCO) hosted a webinar that provides states with information about the benefits of daily Medicare Modernization Act (MMA) file submission. MMCO talked about the how daily submission benefits state, beneficiaries, and providers. Also, two states also shared their lessons learned and best practices regarding daily MMA file submission. This webinar is intended for all state & contractor staff interested in learning more about shifting to daily MMA file submission.
Overview of EDB, MMA Buy-in and TBQ Files
This overview document focuses on the following four CMS data files to provide the similarities and differences between each:
- Enrollment Database (EDB) File
- Medicare Prescription Drug, Improvement, and Modernization Act (MMA) File Exchange
- Buy-in Exchange
- Territory Beneficiary Query (TBQ) File
This document also provides resources and the Centers of Medicare and Medicaid’s contact information. If you are looking for additional information please be sure to contact us.
Home-and Community-Based Services Tip Sheet
This MMA tip sheet provides detail information about the Institutional Status Indicator located in the MMA file. States can use this indicator to identify which full-benefit dually eligible beneficiaries qualify for $0 Part D copayments.
Please see an introduction to the MMA file and MMA submission procedures by visiting the CMS-MMCO MMA page. Click below to visit.
SDRC also maintains a list of Frequently Asked Questions related to the MMA file. Click below to visit.
The MAPD State User Guide provides technical instructions for submitting state data as well as the MMA Request & Response file layouts. Click below to visit.