CMS Expands Access to Medicare Data

The Medicare-Medicaid Coordination Office and the Center for Medicaid, CHIP and Survey & Certification (MMCO-CMCS) sent an informational bulletin to Medicaid state agencies, May 11, informing them of their newly-expanded rights to request certain Medicare Parts A, B, and D data. These privileges are free of charge to states and are intended to improve care for dual eligible beneficiaries at the individual level.

States whose requests are approved can combine Medicare Parts A and B claims and Part D prescription drug event (PDE) data, and link to the state’s Medicaid data for whole-person analysis of the dual eligible experience. States also may request Medicare eligibility and enrollment data on their dual eligibles.

The Centers for Medicare & Medicaid Services (CMS) has permitted states to request access to timely Medicare Parts A and B claims data and Medicare Part D PDE final action data since 2008. And now, states have limited availability to Part D PDE non-final action data (i.e., subject to subsequent adjustment) for the specific purpose of supporting care coordination activities. For all other uses, states will continue to be limited to final action data.

The MMCO-CMCS informational bulletin includes several attachments explaining the process for requesting Medicare data and the limitations to Medicare Part D PDE data.


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