All students, including students with disabilities, participate in state accountability systems. Many students participate in the regular assessment, with or without accommodations, but some students may require participation in an alternate assessment to demonstrate their knowledge and skills. Students with more significant cognitive disabilities may be eligible for the alternate assessment based on alternate achievement standards (AA-AAS). In 2007, federal regulations introduced another assessment option--the alternate assessment based on modified academic achievement standards (AA-MAS). Eligible students may be from any disability category, but they must have Individualized Education Program (IEP) goals based on grade-level content standards. The National Center on Educational Outcomes (NCEO) has been tracking the characteristics of state's AA-MAS since 2007. According to the 2008 NCEO update on test characteristics, nine states had developed what they considered to be an AA-MAS, and only one state (Texas) had received federal approval. The current report found 13 states that by the 2009-10 school year had developed, or were developing, what they considered to be an AA-MAS, and two additional states (Kansas and Louisiana) had received federal approval. In comparison to Albus et al. (2009), the current report found that more states were using constructed response items and fewer states were using performance task items. The current report also tracked test design changes between the AA-MAS and regular assessment. Over half of the states incorporated the following test design changes: distractor removed, fewer items, fewer items per page, key text underlined or bolded, larger font size, shorter passages, and simplified language. In the current analysis three test design changes tracked previously (manipulatives, read-aloud questions and answers, and scribe) were not found for any states. Five test design changes (e.g., additional graphics, graphic organizers, simplified graphics, different typeface, one column format), which were not tracked in previous reports, were included in the current study. This study also tracked whether states' AA-MAS were computer-based and whether the states' documents included considerations for English language learners (ELLs) with disabilities. Four of the thirteen states had a computer-based test. Documents from six states suggested that the needs of ELL students participating in the AA-MAS were considered. Appendices include: (1) State Documents Used in Analysis; and (2) AA-MAS Characteristics by State. (Contains 4 figures and 8 tables.)