Request Process Details

In 2020, CMS developed a single streamlined request process for state Medicaid agencies to assist with the request of data for use in several programs for dually eligible beneficiaries. The data sharing agreement provides the opportunity to request certain elective data files as well as operational data exchanges. The elective data files available for request are those files shared under the Medicare-Medicaid Data Sharing Program, the Territory Beneficiary Query (TBQ) File, and the Enrollment Database (EDB) File. The available operational data exchanges are the State Buy-In File Exchange and the Medicare Modernization Act (MMA) File Exchange.

Under the Medicare-Medicaid Data Sharing Program, a state Medicaid agency can request historical Parts A and B data—including enrollment, claims, and assessments data (Minimum Data Set (MDS), Outcome and Assessment Information Set (OASIS), Swing Bed, and Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI))—and Part D data (also known as Prescription Drug Event (PDE) data). Additionally, if the state Medicaid agency establishes a Coordination of Benefits Agreement (COBA) with CMS, daily or weekly feeds of current Parts A and B data are available.

To help state Medicaid agencies determine which forms are necessary to complete their request, SDRC has compiled request package files for the elective data files and published them below. (There are two major request types—New and Additional Data Use).

NOTE: The two major request types – New and Additional Data Use – are not applicable to the MMA File Exchange or the Buy-in File Exchange

Historical Parts A and B Data: Request Package Files

New Use Request Package

Additional Data Use Request Package

Assessments Data: Request Package Files

New Use Request Package

Additional Data Use Request Package

Daily or Weekly Parts A & B (COBA) Data: Request Package Files

Please note if the state Medicaid agency establishes a Coordination of Benefits Agreement (COBA) with CMS, daily or weekly feeds of current Parts A and B claims data are available.

New Use Request Package

Part D Data: Request Package Files

New Use Request Package

Please note that the conflict of interest templates provided below are suggested guidelines for creating conflict of interest letters. The order and format of the information does not need to follow the template exactly; however, the templates do contain key information requirements, and any variation should be submitted for approval from MMCO and/ or CPI.

Additional Data Use Request Package

Please note that the conflict of interest templates provided below are suggested guidelines for creating conflict of interest letters. The order and format of the information does not need to follow the template exactly; however, the templates do contain key information requirements, and any variation should be submitted for approval from MMCO and/ or CPI.

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