Information for Data Submitters: Fixed Term Travel Nursing Employee Disclosure Report

Overview

Any Temporary Nursing Services (TNS) agency in Massachusetts which employed one or more fixed term travel employees during calendar year 2019 must submit two documents to the Massachusetts Center for Health Information and Analysis.

• Fixed Term Travel Employee Disclosure Form (FTTED)

  The 2019 Fixed Term Travel Employee Disclosure database must be completed with specific information including the nurse's name, license number, facility where he or she worked, and the length of the contract.

• Fixed Term Travel Employee Disclosure Certification Form

  This form attests that all information provided in the FTTED database is true, accurate, and prepared in accordance with applicable instructions and requires an agency representative's signature.

Filing Application

Please email your completed FTTED CSV file and signed Certification form to: CostReports.Pricing@chiamass.gov.

Questions

If you need assistance either completing or submitting these documents, please e-mail CostReports.Pricing@chiamass.gov or call CHIA's Pricing Cost Report Help Desk at (617) 701-8156.