Although some of the DUA forms have been updated to allow for the usage of digital signatures, CMS is currently not accepting digital signatures on DUA forms. We will post a notice on this website when digital signatures will be allowed on DUA forms.
This page does not cover Data Use Agreements (DUA) that have been created specifically for a state research project other than those CMS sponsored programs with the States. For any State initiated research project, refer to our Researchers page.
Changes to a State DUA - In any situation that requires a new DUA or change to a current State DUA (e.g. extension request, change to requester or custodian), we ask that you route all e-mail correspondence through your CMS program representative. If you do not know who to contact regarding your applicable CMS program, contact the CMS Regional Office supporting your State.
Requesting DUA Extensions & Closures - All CMS sponsored state DUAs must be re-validated annually. To retain the use of the data, simply follow the instructions on our DUAs - more actions page.
Requesting Contact Changes - The Requester of a DUA from a State, should be a state employee with an e-mail address issued by an agency of that State (e.g. email@example.com or firstname.lastname@example.org). There is no restriction on who may or may not be listed as the Custodian(s) on a State DUA. Please follow the instructions on our DUAs - more actions page for all DUA contact changes.
Some of the CMS sponsored programs for States/Territories that require a DUA are:
Coordination of Benefits (COB) and Third Party Liability
Since 2006, and annually thereafter, CMS has been collecting information on state pharmaceutical assistance programs (SPAPs) about their eligibility requirements and benefit structures. This collection of SPAP benefit information allows CMS to better understand the unique coordination activities and changes that take place between the SPAPs and Part D plan sponsors prior to the beginning of the enrollment period for the next calendar year. The SPAP template will be filled out by the SPAP and returned to CMS, where the information is housed in the Medicare Drug Benefit Group (MDBG). For more information, e-mail SPAP@cms.hhs.gov.
Medicare's Enrollment Database (EDB)
The EDB is the authoritative source for all Medicare entitlement information. This database contains information on all individuals entitled to Medicare, including demographic information, enrollment dates, third party buy-in information, and Medicare managed care enrollment. As these records are comprehensive and updated daily, the EDB is the superior source for current, complete Medicare enrollment information. CMS has developed a custom "view" of the EDB data for States. States may send CMS a file of Medicaid beneficiary identifiers (SSNs) that will be compared with information in the EDB to determine which Medicaid beneficiaries are also eligible for Medicare. To obtain an EDB extract for your State you will need to complete an EDB Customized State Data Use Agreement (DUA) form and return the DUA form to CMS for approval. For more information, contact the CMS Regional Office supporting your State.
State Health Insurance Assistance Program (SHIP) National Performance Reporting (NPR)
The SHIP NPR system is a uniform performance data collection and reporting system for all SHIP grantees. The SHIP was established in Section 4360 of Public Law 101-508. SHIPs provide a health insurance advisory service to assist Medicare beneficiaries with the receipt of services under Medicare, Medicaid and other health insurance programs. CMS is legislatively required to assess SHIP performance, and CMS uses data gathered by the SHIP NPR system. The system supports data reporting and performance data analysis so that CMS and SHIPs can assess the SHIP performance, evaluate program development and quality assurance impacts.
For more information send an e-mail to SHIP@cms.hhs.gov.
State Systems Ability to Pay - ARRA HITECH Provider EHR Incentive Program
The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. States may voluntarily offer the Medicaid EHR Incentive Program to their Medicaid eligible professionals and eligible hospitals.
Visit EHR Incentive Program web site for more information or send an e-mail to HBOSC_POSD@cms.hhs.gov with your specific question(s).
Questions regarding a State DUA may be addressed with the CMS Regional Office supporting your State, the CMS Program Representative or by sending an e-mail to DataUseAgreement@cms.hhs.gov.
- Page last Modified: 01/08/2014 4:07 PM
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