MedicaidDocumentationMedium impact
2024.31 - Provider Bulletin - Attestation Form for Qualifying Clinical Trials PDF
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
May 1, 2024
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (CMAP) has released a new attestation form that must be completed for all Medicaid patients participating in qualifying clinical trials. The form documents appropriateness of the trial and must be kept in patient records for at least 5 years, but is not submitted with claims unless specifically requested.
Action Required
Immediately: Download the Medicaid Attestation Form for Qualifying Clinical Trials from www.ctdssmap.com under Authorization/Certification Forms. Providers must complete this form before starting any clinical trial for HUSKY Health members, obtain required signatures from Principal Investigator and/or Healthcare Provider, and retain completed forms in patient medical records for minimum 5 years. Do not submit forms with claims unless specifically instructed by DSS or CHNCT.