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Submitting a HCIA Operations DUA Request
Molly Emerick, MPH
Technical Advisor
Work performed under CMS Contract #HHSM-500-2013-00166C
Overview
Describe the request process
Provide a detailed review of the required
materials for an Operations DUA request
Discuss each request document and tips for
completion
Provide resources
2 Work performed under CMS Contract #HHSM-500-2013-00166C
Overview of Request Process
3
Researcher ResDAC CMS GDIT
Draft
Packet
Packet
Revisions Reviews
Final Packet CMS Analyst
Privacy
Board
Decision
Notification
Processing/
Onboarding
Work performed under CMS Contract #HHSM-500-2013-00166C
Process may take 8-12 weeks
CMMI PO
identifies as
Operations
ResDAC CMMI Request Center
4 Work performed under CMS Contract #HHSM-500-2013-00166C
Request Materials & Tips for Completion
5 Work performed under CMS Contract #HHSM-500-2013-00166C
Request Materials List
Request Document Notes
1. Request Letter ResDAC has created a template
2. Data Use Agreement Please complete the 6-page DUA.
3. DUA Attachment B Acknowledgement that requestor is allowed to identify
physicians.
4. Signature Addendum Form Used to add additional people to the DUA.
5. Evidence of Funding Include the CMS grant award face sheet as evidence that this
request is an CMMI awardee and therefore, data are free of
charge.
6 Work performed under CMS Contract #HHSM-500-2013-00166C
Request Materials List, continued
Request Document Notes
6. Information Only No Fee
Cost Invoice
ResDAC will produce an information only, no fee cost invoice
so that all individuals involved with the request know that
there is no charge for the data and why.
7. CMMI Specifications
Worksheet
This document outlines the data that are requested and
where data are to be shipped.
General Justification tab required
8. HIPAA Attestation Document that requests the researcher identify whether the
request is being submitted as a Research or Health Care
Operations request.
Other file specific materials Examples include: Variable justifications for Part D and
Assessment data and Part D DUA Attachment A
7 Work performed under CMS Contract #HHSM-500-2013-00166C
1. Request Letter
8
Work performed under CMS Contract #HHSM-500-2013-00166C
4. Data Use Agreement
9
CMS will
assign after
submission
This should
be the
Awardee
Organization
Name
Work performed under CMS Contract #HHSM-500-2013-00166C
Data Use Agreement
10
Insert a CMS contract No
if you have received one.
Most requests will not
have one.
Work performed under CMS Contract #HHSM-500-2013-00166C
Include the name of the
project.
Data Use Agreement
11
List specific files and
years requested.
Leave SOR blank.
Year for the
crosswalk files
should be the year
that it was provided.
(i.e. 2015)
CMS has an
automatic 1 yr
retention period.
Work performed under CMS Contract #HHSM-500-2013-00166C
Data Use Agreement
12
If signature addenda
are needed, include
under #12 as well as
Attachment A and/or
B.
Work performed under CMS Contract #HHSM-500-2013-00166C
Data Use Agreement
13
#16 is the individual
that is authorized to
sign on behalf of the
Requesting
Organization.
#17 is the individual
that is responsible for
the data security.
Work performed under CMS Contract #HHSM-500-2013-00166C
Must include
physical address
(No PO Boxes).
Data Use Agreement
14
CMMI PO will sign #20 after final package is submitted to CMS.
Work performed under CMS Contract #HHSM-500-2013-00166C
4a – DUA Attachment B
15
Person that signed #16 of DUA should sign here.
Work performed under CMS Contract #HHSM-500-2013-00166C
5. Signature Addendum to the DUA
16 Work performed under CMS Contract #HHSM-500-2013-00166C
Insert study name
as it appears on
the DUA.
Please select
custodian.
Must include
physical address. Must be physical
signature.
6. Evidence of Funding
17
Work performed under CMS Contract #HHSM-500-2013-00166C
7. Information Only No Fee Cost Invoice
18
ResDAC will supply to the requestor
Work performed under CMS Contract #HHSM-500-2013-00166C
8. Specification Worksheet
19
General Justification
Work performed under CMS Contract #HHSM-500-2013-00166C
8. Specifications Worksheet
Data Request Details
20
Work performed under CMS Contract #HHSM-500-2013-00166C
8. Specifications Worksheet
Contact Information
21
Work performed under CMS Contract #HHSM-500-2013-00166C
This should be the
individual that is
knowledgeable
about the request.
This should be the
individual that
signed #16 of the
DUA.
10. HIPAA Attestation
22 Work performed under CMS Contract #HHSM-500-2013-00166C
Request Materials List, continued
Request Document Notes
File Specific Materials
11. Part D Variable
Justification
Please provide the Part D variable justification worksheet that
is found within the specifications worksheet.
12. DUA Part D Attachment A If requesting Part D data, requestor should sign the Part D
Attachment A
13. Assessment Variable
Justification
The Assessment variable justification worksheets are
separate Excel spreadsheets found on our website.
23 Work performed under CMS Contract #HHSM-500-2013-00166C
File Specific Materials 11. Part D variable justification worksheet
24
Work performed under CMS Contract #HHSM-500-2013-00166C
Select the
variable, provide
reason for
selection, & risk
level.
File Specific Materials 12. Part D Attachment A
25
Work performed under CMS Contract #HHSM-500-2013-00166C
File Specific Materials 13. Assessment variable justification worksheet
26
Work performed under CMS Contract #HHSM-500-2013-00166C
Select the
variable, provide
reason for
selection.
Resources
Templates are available on the website
“Tips” documents are available for several of the
request documents. It provides an explanation of
what is needed for each document and question.
27 Work performed under CMS Contract #HHSM-500-2013-00166C
What Next?
Prepare a draft (no signatures)
Email to [email protected] and request a review
ResDAC staff will guide you through the review
process.
28 Work performed under CMS Contract #HHSM-500-2013-00166C
Healthcare Operations Request Process
29 Work performed under CMS Contract #HHSM-500-2013-00166C
Step 1 •Awardee and CMS Project officer designate request as Healthcare Operations
Step 2
•Requestor obtains materials from ResDAC CMMI website
•Requestor emails drafts to [email protected]
Step 3 •ResDAC reviews and provides comments/corrections
Step 4 •Requestor revises all, obtains necessary signatures, and returns finals to ResDAC
Step 5 •ResDAC forwards finals to CMS
Step 6
•CMS Privacy Board reviews
•Privacy analyst sends decision notification to Eric Hanson and Gino Sisti; Eric or Gino sends to CMMI PO, requestor, and GDIT
Step 7 •GDIT processes data request and prepares physical shipment or onboarding to VRDC
Summary
Request materials will be on ResDAC website
Templates, tips documents, and webinars
available on ResDAC website
ResDAC staff are available by phone and email to
answer any questions you have when completing
the materials
˗ Email: [email protected]
˗ Phone: 1-888-973-7322
˗ Web: http://www.resdac.org
30
Work performed under CMS Contract #HHSM-500-2013-00166C