State Data for the Medicare Modernization Act (MMA) (CMS-10143)

OMB 0938-0958

The monthly file of dual eligible enrollees will be used to determine those duals with drug benefits for the phased down State contribution process required by the Medicare Modernization Act of 2003 (MMA).

The latest form for State Data for the Medicare Modernization Act (MMA) (CMS-10143) expires 2023-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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)

All Historical Document Collections

202310-0938-008 Approved without change	Revision of a currently approved collection	2023-10-31
202005-0938-016 Approved without change	Revision of a currently approved collection	2020-05-28
201903-0938-005 Comment filed on proposed rule and continue	Revision of a currently approved collection	2019-03-07
201808-0938-012 Approved without change	Revision of a currently approved collection	2018-08-28
201511-0938-010 Approved without change	Revision of a currently approved collection	2015-11-20
201212-0938-002 Approved without change	Reinstatement with change of a previously approved collection	2012-12-07
200807-0938-002 Approved without change	Extension without change of a currently approved collection	2008-07-10
200506-0938-004 Approved without change	New collection (Request for a new OMB Control Number)	2005-06-08

OMB Details

Monthly State File of Medicaid/Medicare Dual Eligible Enrollees

Federal Enterprise Architecture: Health - Health Care Services