Since 2005, states 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 full benefit dual eligible individuals and partial benefit dually eligible individuals (i.e., who just get Medicaid help with Medicare premiums, and often for cost-sharing). The file is called the “MMA File” (after the Medicare Prescription Drug Improvement and Modernization Act of 2003), or State Phasedown File.
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) File Exchange is the state’s data exchange that provides current information on updated full-benefit dually eligible and partial-benefit dually eligible beneficiary status (i.e., those who get Medicaid help with Medicare premiums, and often for cost-sharing). The state sends data on the MMA File to the CMS Medicare Beneficiary Database (MBD). For each “request file” received from the state, the CMS MBD generates an MMA Response File to the state. While states are required to exchange data monthly, the state can exchange as frequently as daily.
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 and TBQ Files
This overview document focuses on the following three 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
- 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.