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RY2025 MassHealth Clinical Quality Incentive (CQI) Program Hospital Quality Contacts Form

Pursuant to the Acute Hospital RFA (Section 7B), the hospital must provide contact information on all designated staff involved in quality reporting during the contract Rate Year.

INSTRUCTIONS: The Hospital must enter all required information and include an effective date on this form. A confirmation email with the submitted responses will be sent to the submitter's email address entered at the bottom of this form. Note: The hospital should retain a copy of this email for its records.

If there are changes to the quality contacts listed on this form during the rate year, the hospital must complete and submit a new updated online form.

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