What are the federally required disclosures for MassHealth?

MassHealth providers, MCEs, fiscal agents, and other disclosing entities seeking to provide MassHealth services must disclose information about business ownership and control, business transactions, and criminal convictions.

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MA Disclosure of Ownership and Control Interest Statement

Get MA Disclosure of Ownership and Control Interest Statement

Information may result in a refusal by the Secretary or appropriate State agency to enter into an agreement or contract with any such institution or in termination of existing agreements. General Instructions Please answer all questions as of the current date. If the yes block for any item is checked, list requested additional information under the Remarks section on page 2, referencing the item number to be continued. If additional space is needed use an attached sheet. Return the original an.

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