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    Mental Health & Substance Abuse Reporting Requirements

    In order to monitor service provision, expenditures and consumer outcomes, the Department requires Substance Abuse Coordinating Agencies (CAs), Community Mental Health Services Providers (CMHSPs), and Pre-Paid Inpatient Health Plans (PIHPs) to provide information and data on topics such as costs, services, consumer demographics, and administrative activities. The following is a list of key instructional documents for reporting to the Mental Health and Substance Abuse Administration.  
    (Click here for data reports and statistics.)  



      Administrative Cost Reporting - Forms and Instructions  

    Administrative Cost Reporting Fiscal Year 2013  
     Forms and Instructions Revised and Posted for FY12 Expenditures per 
     FY13 General Fund Contract Section 7.8 & 7.8.1  
     Last Updated 1/9/2014 


    Previous Years 2009 - 2012 


     Annual Submission Requirement Forms and Instructions  
     Last Updated 1/10/2014

     Financial Status Reporting  

     Financial Status Reporting Fiscal Year 2013
     Contract Requirements Per General Fund Section 7.8 and 7.8.1 and Medicaid Section 7.8 and 7.8.1 
      Last updated 5/14/2013

      Previous Years FY2009 - FY2012 

     Medicaid Hospital Rate Adjustment (HRA) Annual Report  
     Last updated 1/9/2014 

    Contract Requirements Per Medicaid Section 7.8 and 7.8.1 



    FY 2011 

     FY 2010 




    Instructions for Reporting Financial Information
    Date Posted:  4/22/2013 

    Documentation on how to report financial information via the 837 including charged and paid amount, and provider identification.



    Instructions for Generating a CAFAS® and PECFAS® Aggregate Reports - Instructions for generating aggregate annual Child and Adolescent Functional Assessment Scale (CAFAS) and Pre-School and Early Childhood Functional Assessment Scale (PECFAS) reports.
    Last Updated 11/21/2013 


    -  MDCH/PIHP Event Reporting FY11 
    Last Updated 11/1/2010
    Documentation on how to report to the Event Reporting System. Includes requirements, coding instructions, technical specification and the Implementation Guide. Current reporting includes suicides, non-suicide deaths, emergency medical treatment due to injury or medication error, hospitalizations due to emergency or medication error, and arrests for reportable populations . 



     -   PIHP FY13 Medicaid Utilization and Cost Reporting Form for Specialty Services, the Adult Benefit Waiver (ABW) and Autism Cost Reporting Template      
        Reporting Instructions for Specialty ServicesABW, Medicaid Autism and for
         MiChild Autism  
        Last Updated - Revised 2/18/2014.
          Template for PIHP FY13 Medicaid, ABW and Autism Cost Reporting. (Oct. 2012 - Sept. 2013)
           Due date February 28, 2014 5:00 P.M.


     -   CMHSP FY13 Sub-Element Cost Reporting Form          
     and       Reporting Instructions 
     Last Updated 2/18/2014  Template for CMHSP FY13 Cost Reporting. (Oct 2012-Sept 2013)
       Due date February 28, 2014 5:00 P.M.


    CMHSP FY13 General Fund Cost Reporting Form and Reporting Instructions 
      Last Updated 2/18/2014.
       Template for CMHSP FY13 General Fund Cost Reporting (Oct 2012-Sept 2013).
       Due date February 28, 2014 5:00 P.M.


    NPI Reporting Guidelines for 837 Encounter Transactions  
       October 17, 2007 


    PIHP/CMHSP Encounter Reporting Costing Per Code and Code Chart    
      Last Updated 4/1/2014
    Includes all reportable HCPCS and Revenue codes for mental health.  Contains updated instructions on   use of modifiers and the acceptable activities that may be reflected in the cost of each procedure such as whether an activity needs to be face-to-face.


    Michigan's Mission-Based Performance Indicator System, Ver. 6.0
    Last Updated 12/18/2013

        CMHSP Reporting Codebooks (Last Updated 12/18/2013) 
        PIHP Reporting Codebooks  
       (Last Updated 12/18/2013)  

    Detailed instructions for reporting the FY12 Performance Indicators. Includes codebooks. Required for PIHPs, CMHSPs & CAs
        CMHSP Template 
     (Last Updated 12/18/2013)
        PIHP Template   (Last Updated 12/18/2013)
        CMHSP Recipient Rights Reporting Template  
        PIHP Recipient Rights Reporting Template  




    Private Duty Nursing Authorizations Manual Posted 8/25/2010
    The User Manual guides CMH staff who are authorized through CHAMPS to enter prior authorizations for private duty nursing.   


    Submitting Medicaid Substance Abuse Encounters (9/05)  
    In order to be in compliance with the Balanced Budget Act, Medicaid encounters for services provided by the Substance Abuse Coordinating Agencies (CAs) are to be received electronically by the Department via the Prepaid Inpatient Health Plans (PIHPs). The attached provides instructions for use with FY 06 encounters. This document also includes related instructions on Plan and Submitter IDs.  

    >   Instructions for use with FY06 encounters  


    Instructions for Reporting Facility Provider Type (11/04)  
    PIHP and CMHSP Instructions for reporting the inpatient hospital provider type for the servicing facility on the 837 Institutional. Provider Types include state hospital, community inpatient, institute for mental disease (IMD) and Intermediate Care Facility for the Mentally Retarded (ICF/MR). See also, listing of hospitals and reporting codes.  

    >   Instructions for Reporting Facility Provider Type  XXXX  


    If you have questions on this material, please e-mail Kathy Haines at  






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