Financial Status Reporting Fiscal Year 2021

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 19

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 - MI Health Link

FSR Bundle - Tab

Instructions

9

Financial Status Report - Health Homes Services

FSR Bundle - Tab

Instructions

10

Financial Status Report -  Substance Use Disorder Services

FSR Bundle - Tab

Instructions

11

Supplemental Financial Status Report - Substance Use Disorder Services

FSR Bundle - Tab

Instructions

12

Restricted Fund Balance Activity (PA2 / PBIP)

FSR Bundle - Tab

Instructions

13

Medicaid - Internal Service Fund

FSR Bundle - Tab

Instructions

14

Medicaid Shared Risk Calculation & Risk Financing

FSR Bundle - Tab

Instructions

15

Financial Status Report - All Non-Medicaid

FSR Bundle - Tab

Instructions

16

General Fund Contract Reconciliation and Cash Settlement

FSR Bundle - Tab

Instructions

17

General Fund Contract Settlement Worksheet

FSR Bundle - Tab

Instructions

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

19

Special Fund Account for Recipient Fees and Third-Party Reimbursement

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

Substance Use Disorder Non-Medicaid - Year End Accrual Schedule

Stand Alone Form

Instructions

25

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

Stand Alone Form for Quarterly Reporting Only

Instructions

26

Executive Salaries and Benefit Compensation Report 

 

 

27

New County 10% Billing Process