OMB control number
State Data for the Medicare Modernization Act (MMA) (CMS-10143)
OMB 0938-0958 · HHS/CMS.
OMB 0938-0958
The Medicare Advantage Prescription Drug (MAPD) State User Guide contains technical guidance for the state and file layouts of the MMA Request (state sends to CMS) and Response (CMS returns to state) files. Please see the attached Crosswalk and Track Change version of the guide for details. The MMA request file identifies all dually eligible beneficiaries in the state for the current month. As noted above in section A1, the phase-down process requires a monthly count of all full-benefit dually eligible beneficiaries with a dual status code of 02, 04, and 08 and an active Part D plan enrollment in the month.
The latest form for State Data for the Medicare Modernization Act (MMA) (CMS-10143) expires 2027-01-31 and is listed under ICR 202310-0938-008.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 CMS-10143 - Supporting Statement Part A (2023 version 5).docx | Supporting Statement A |
 Monthly State File of Medicaid/Medicare Dual Eligible Enrollees |
Instruction |
| ? 423.910 (One-time System Update) |
Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202310-0938-008 | Revision of a currently approved collection | 2023-10-31 | Approved without change | |
| 202005-0938-016 | Revision of a currently approved collection | 2020-05-28 | Approved without change | |
| 201903-0938-005 | Revision of a currently approved collection | 2019-03-07 | Comment filed on proposed rule and continue | |
| 201808-0938-012 | Revision of a currently approved collection | 2018-08-28 | Approved without change | |
| 201511-0938-010 | Revision of a currently approved collection | 2015-11-20 | Approved without change | |
| 201212-0938-002 | Reinstatement with change of a previously approved collection | 2012-12-07 | Approved without change | |
| 200807-0938-002 | Extension without change of a currently approved collection | 2008-07-10 | Approved without change | |
| 200506-0938-004 | New collection (Request for a new OMB Control Number) | 2005-06-08 | Approved without change |
OMB Details
Monthly State File of Medicaid/Medicare Dual Eligible Enrollees
Federal Enterprise Architecture: Health - Health Care Services