Financial Status Reporting Fiscal Year 2020

Contact: MDHHS-BHDDA-CONTRACTS-MGMT@michigan.gov

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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 18

Tabs (as follows)

 

4

Medicaid Contract Settlement Worksheet

FSR Bundle - Tab

Instructions

5

Medicaid Contract Reconciliation and Cash Settlement

FSR Bundle - Tab

Instructions

6

Financial Status Report - Medicaid

FSR Bundle - Tab

Instructions

7

Financial Status Report - Healthy Michigan Plan 

FSR Bundle - Tab

Instructions

8

Financial Status Report - Health Homes Services

FSR Bundle - Tab

Instructions

9 Financial Status Report - Opioid Health Home Services FSR Bundle - Tab Instructions

10

Financial Status Report - MI Health Link

FSR Bundle - Tab

Instructions

11

Restricted Fund Balance Activity (PA2 / PBIP)

FSR Bundle - Tab

Instructions

12

Medicaid - Internal Service Fund

FSR Bundle - Tab

Instructions

13

Medicaid Shared Risk Calculation & Risk Financing

FSR Bundle - Tab

Instructions

14

Financial Status Report - All Non-Medicaid

FSR Bundle - Tab

Instructions

15

Financial Status Report - All Non-Medicaid Supplemental

FSR Bundle - Tab

Instructions

16

Financial Status Report - All Non-Medicaid DCW Supplemental

FSR Bundle - Tab

Instructions

17

General Fund Contract Reconciliation and Cash Settlement

FSR Bundle - Tab

Instructions

18

General Fund Contract Settlement Worksheet

FSR Bundle - Tab

Instructions

19

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

FSR Bundle - Tab

Instructions

20

Financial Status Report - Certification Page

FSR Bundle - Tab

Instructions

21

Financial Status Report - Additional Narrative

FSR Bundle - Tab

 

22

Medicaid - Year End Accrual Schedule

Stand Alone Form

Instructions

23

General Fund - Year End Accrual Schedule

Stand Alone Form

Instructions

24

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

Stand Alone Form for Quarterly Reporting Only

Instructions

25

Executive Salaries and Benefit Compensation Report