Financial Status Reporting Fiscal Year 2017

Contact: John Duvendeck, Contracts & Policy (517) 241-5218

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Report Form
(Excel)

Form
Description

Instructions
(PDF)

1

Report Certification & Electronic Report Submission Guidelines

 

Instructions

2

Midyear Report

Stand Alone Form

Instructions

3

FSR Combined Reports (Bundle)

Workbook with 19

Tabs (as follows)

 

4

Financial Status Report - Medicaid Contract Settlement

FSR Bundle - Tab 1

Instructions

5

Medicaid Contract Reconciliation and Cash Settlement

FSR Bundle - Tab 2

Instructions

6

Financial Status Report - Medicaid

FSR Bundle - Tab 3

Instructions

7

Financial Status Report - Healthy Michigan Plan 

FSR Bundle - Tab 4

Instructions

8

Financial Status Report - MI Health Link

FSR Bundle - Tab 5

Instructions

9

Financial Status Report - Health Homes Services

FSR Bundle - Tab 6

Instructions

10

Financial Status Report - Autism Benefit

FSR Bundle - Tab 7

Instructions 

11

Financial Status Report & CRCS Supplemental - Autism Benefit

FSR Bundle - Tab 8

Instructions

12

Financial Status Report -  Substance Use Disorder Services

FSR Bundle - Tab 9

Instructions

13

Supplemental Financial Status Report - Substance Use Disorder Services

FSR Bundle - Tab 10

Instructions

14

Restricted Fund Balance Activity (PA2 / PBIP)

FSR Bundle - Tab 11

Instructions

15

Medicaid - Internal Service Fund

FSR Bundle - Tab 12

Instructions

16

Medicaid Shared Risk Calculation & Risk Financing

FSR Bundle - Tab 13

Instructions

17

Financial Status Report - All Non-Medicaid

FSR Bundle - Tab 14

Instructions

18

General Fund Contract Reconciliation and Cash Settlement

FSR Bundle - Tab 15

Instructions

19

General Fund Contract Settlement

FSR Bundle - Tab 16

Instructions

20

Special Fund Account for Recipient Fees and Third-Party Reimbursement

FSR Bundle – Tab 17

Instructions

21

Financial Status Report - Pasted Certification Page

FSR Bundle - Tab 18

Instructions

22

Financial Status Report - Additional Narrative

FSR Bundle - Tab 19

 

23

Medicaid - Year End Accrual Schedule

Stand Alone Form

Instructions

24

General Fund - Year End Accrual Schedule

Stand Alone Form

Instructions

25

Substance Use Disorder Non-Medicaid - Year End Accrual Schedule

Stand Alone Form

Instructions

26

Special Fund Account - Section 226a, PA423 of the MHC

Stand Alone Form for Quarterly Reporting Only

Instructions

27

Executive Salaries and Benefit Compensation Report