MassHealth CQI Program Participant Documents

Program Participant Forms

Hospitals that participate in the MassHealth Clinical Quality Incentive Program reporting, under the Acute Hospital Request for Application (RFA) contract, must complete forms that apply to each rate year.

You can download the standard forms that apply to all hospitals below.

Additional Resources

RY2026 Hospital Quality Contacts Form: (online form)
RY2026 Hospital Data Accuracy and Completeness Attestation Form: PDF | Word
MassHealth Data Validation Reevaluation Form: PDF | Word
MassHealth Extraordinary Circumstance Request Form: PDF | Word

Refer to the reporting instruction document on how to complete and submit all required forms.

RY2026 CQI Forms Reporting Instruction: PDF | Word

Contact

Date published:	September 27, 2023
Last updated:	September 22, 2025

Date published:

September 27, 2023

Last updated:

September 22, 2025

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MassHealth CQI Program Participant Documents

Program Participant Forms

Additional Resources

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MassHealth CQI Program Contact

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