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HOW TO REQUEST MEDICAL ASSISTANCE DATA
Thank you for your interest in advancing best practices and policies through analysis of Maryland Medicaid data.
The DHMH Planning Administration team looks forward to working with you.
The data request process is outlined below.
Please submit all required information and any collateral questions, comments or concerns to
Online forms and documents are best accessed when using Google Chrome as the web browser. The links and forms on this page may not be immediately compatible with other web browser types.***
To view Frequently Asked Questions (FAQs) about authorized Medicaid Data Requests, click
. The forms referenced in the FAQs are listed immediately below:
DHMH IRB Protocol Modification Form
DHMH Continuous Review Application Form
Certificate of Study Closure
Certificate of Data Destruction
Data Request Submission
Complete the Maryland Medicaid Data Request Form.
This form may be downloaded and submitted by e-mail to
or complete the online Maryland Medicaid Data Request Google form.
To download the form, click
To complete the form online, click
Via this form, address each of the following points if relevant to your study:
Proposed Project’s Central Aim, Goals and Objectives
HealthChoice Managed Care Organization Claims Data
Fee-for-Service Claims Data
Pharmacy Claims Data
All of the Above
Other Data Needed (Specify)
Planned Data Analyses & Software Tools to Be Applied (e.g., SAS, SPSS, Stata)
Time Period of Needed Data (Date of Onset … Date of Offset)
Targeted Medicaid Beneficiary Population(s) To Be Studied
Targeted Beneficiary Characteristics (e.g., Race, Age, Gender, ZIP Code, Other Demographics of Interest)
Targeted Diagnoses, including a listing of relevant ICD Diagnostic Codes (Note:
When indicated, take into account timing of
migration from ICD-9 to ICD-10 codes on October 1, 2015.)
Targeted Health & Related Services To Be Evaluated, including a listing of relevant CPT, HCPCS or other revenue/reimbursement codes
Targeted Service Locations or Provider Types
Other Key Parameters of Needed Data Sample
You may be contacted by e-mail or telephone if there are questions regarding your data request.
Step 2: Generation / Execution of Inter-Agency Agreement & Data Use Agreement
Under certain circumstances the DHMH team will allow the research team to simultaneously pursue Steps 2 and 3, or to complete Step 3 prior to completing Step 2.]
Depending on the nature and scope of the data request, the Principal Investigator (PI) and her/his organization may be required to enter into an Inter-Agency Agreement (IAA) and a Data Use Agreement (DUA) with DHMH and other participating legal entities prior to the release of any data.
This determination will typically be made during the review of the submitted Data Request Form.
The IAA will include:
A brief description of the research project and data to be shared; and
Specific duties of each party to the agreement, such as requirements to submit periodic reports and updates to reflect changes in study design or procedures that affect the rights and interests of Medicaid recipients and the period of the agreement.
The DUA will include specifications regarding:
Data to be released and data ownership rights;
Scope of work and permitted uses of the covered data;
Permitted users of the covered data;
Data security, including provisions regarding confidentiality, breach of agreement, data management plan, data storage location, and data destruction.
Each party to these agreements will be required to submit source information to
for use by the DHMH legal team during its generation of draft agreements.
To download the source information collection tool, click
To complete the source information collection tool online, click
To download outlines with instructions of each attachment to the Data Use Agreement, click
To complete a required Data Use Agreement Quarterly Report online, click
DHMH IRB Review & Approval
Certain data requests require approval by the DHMH Institutional Review Board (IRB).
Additional information regarding this process is available through the IRB website:
The basic process is outlined below.
Questions regarding the IRB process may be submitted to Ms. Gay Hutchen, IRB Administrator,
Download and complete required IRB Form 1 (DHMH 2124) from the DHMH IRB home page.
Click here for
Form 1 (DHMH 2124)
You will need to attach to this form:
a narrative description of the proposed research,
fully drafted informed consent form (if applicable),
copy of each data collection instrument to be used (if any),
the results of prior IRB reviews (if any); and
any other supportive material that serves to clarify prospective participant risks and benefits specific to the proposed protocol.
Submit one copy of the completed IRB Form 1 (DHMH 2124), all attachments, and a cover letter on the PI’s letterhead to
The PI must sign and date the first page of Form 2124.
An incomplete form, or a form not accompanied by the required attachments, will be returned to the Principal Investigator for additional work.
Final Approval of Data Request before IRB Submission
The submitted IRB Form 1 (DHMH 2124) will be reviewed by the Director of Maryland Medicaid Planning or her designee.
If the request is approved, the Medicaid Planning team will provide the PI with an approved (i.e., signed and dated) copy of the previously submitted IRB Form 1 (DHMH 2124) by email.
Formal Submission to IRB
Upon receipt of this signed and approved IRB Form I (DHMH 2124), either the PI or the Medicaid Planning team will agree to assume responsibility for submitting the requisite number of copies of it (10 copies for full board review; 4 copies for expedited review), along with the required attachments, to the DHMH IRB located at:
DHMH Institutional Review Board
201 West Preston Street, 5
Baltimore, Maryland 21201
If the IRB packet is to be submitted by the PI to the IRB, upon completion of this step the PI is to notify the DHMH Planning Administration team via email sent to:
Similarly, if the IRB packet is submitted by the Medicaid Planning team the PI will be notified.
Initiation of Data Release
Once all relevant prior steps (1-5b) have been completed satisfactorily, the requested data will be released to the authorized data recipient.
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464
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