Nursing Facility Cost Reporting Forms and Instructions Applicable to Prior Periods

This page contains prior periods cost reporting forms and instructions 

For cost reporting forms and instructions applicable to current period, click here.  

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Note - Cost Report templates have been tested with Microsoft Office 97, 2000, and XP

Medicaid Electronic Provider Cost Report Template, Version Applicable to 2004 through 2007:  Applicable to cost reporting periods that begin on or after March 1, 2004 and prior to May 31, 2007. Incorporates a new cost reporting schedule.  CR200403.xlt

Cost Report Instruction Manual, Version Applicable to 2004:  Detail page by page instructions on how to complete the cost report template 2004-03.  Can be printed onto 48 letter size pages.   Instruction_Manual_CR200403.doc

Medicaid Electronic Provider Cost Report Template, Version Applicable to 2003:  Applicable to cost reporting periods that begin on or after November 1, 2003 and prior to January 31, 2004. Reflects change Base to Support Ratio Percentage, used with contracted services cost.  CR200311.xlt

Medicaid Electronic Provider Cost Report Template, Version Applicable to 2001 through 2003:  Applicable to cost reporting periods that begin on or after October 1, 2001 and prior to October 31, 2003. Reflects changes due to Quality Assurance Assessment Program.  CR200110.xlt

Cost Report Instruction Manual, Version Applicable to 2001 through 2003:  Detail page by page instructions on how to complete the cost report template 2001-10 and 2003-11.  Can be printed onto 48 letter size pages.   Instruction_Manual_CR200110.doc

Medicaid Electronic Provider Cost Report Template, Version Applicable to 2000 through 2001:  Applicable to cost reporting periods that begin on or after October 1, 2000 and prior to September 30, 2001. Reflects a change in the Wage Pass Through Program Reimbursement. New Benefits are eligible for inclusion in the Wage Pass Through reimbursement.  CR200010.xlt

Cost Report Instruction Manual, Version Applicable to 2000 through 2001:  Detail page by page instructions on how to complete the cost report template 2000-10.  Can be printed onto 48 letter size pages.   Instruction_Manual_CR200010.doc

Incentive Grant Cost Reporting:  Supplemental Cost Reporting Form, applicable to cost reporting periods that begin on or after October 1, 2000 and prior to September 30, 2001. Form must be completed and filed with all cost reports submitted. Form clarifies grant expenditures reported in cost report.   Incentive_Grant_Cost_Reporting.xls

Medicaid Electronic Provider Cost Report Template, Version Applicable to 1999 through 2000:  Applicable to cost reporting periods that begin on or after October 1, 1999 and prior to September 30, 2000. Reflects a change in the Wage Pass Through Program Reimbursement. New Benefits are eligible for inclusion in the Wage Pass Through reimbursement.  CR199910.xlt

Cost Report Instruction Manual, Version Applicable to 1999 through 2000:  Detail page by page instructions on how to complete the cost report template 1999-10.  Can be printed onto 48 letter size pages.   Instruction_Manual_CR199910.doc

Medicaid Electronic Provider Cost Report Template, Version Applicable to 1998 through 1999:  Applicable to cost reporting periods that begin on or after October 1, 1998 and prior to September 30, 1999. Reflects a change in the Wage Pass Through Program reimbursement. New benefits arenot eligible for inclusion in the Wage Pass Through reimbursement.   CR199810.xlt

Cost Report Instruction Manual, Version Applicable to 1999 and prior periods:  Detail page by page instructions on how to complete the cost report template 1998-10, 1997-10, and 1995-09.  Can be printed onto 46 letter size pages.   Crmanual.doc

Medicaid Electronic Provider Cost Report Template, Version Applicable to 1997 through 1998:  Applicable to cost reporting periods that begin on or after October 1, 1997 and prior to September 30, 1998. Reflects a change in the Wage Pass Through Program reimbursement. Associated costs percentage related to wages was changed from 16.22% to 12.50%.   CR199710.xlt

Medicaid Electronic Provider Cost Report Template, Version Applicable to 1995 through 1997:  Applicable to cost reporting periods ending prior to September 30, 1997. Can be printed onto either 120 letter size pages or 80 legal size pages.  CR199509.xlt