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Financial Status Reporting Fiscal Year 2022

#

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 - CCBHC FSR Bundle - Tab Instructions
9 Financial Status Report - CCBHC Supplemental FSR Bundle - Tab Instructions

10

Financial Status Report - Health Homes Services

FSR Bundle - Tab

Instructions

11

Financial Status Report - Opioid Health Home Services

FSR Bundle - Tab

Instructions

12

Financial Status Report - MI Health Link

FSR Bundle - Tab

Instructions

13

Restricted Fund Balance Activity (PA2 / PBIP)

FSR Bundle - Tab

Instructions

14

Medicaid - Internal Service Fund

FSR Bundle - Tab

Instructions

15

Medicaid Shared Risk Calculation & Risk Financing

FSR Bundle - Tab

Instructions

16

Financial Status Report - All Non-Medicaid

FSR Bundle - Tab

Instructions

17

Financial Status Report - All Non-Medicaid Supplemental

FSR Bundle - Tab

Instructions

18

Financial Status Report - All Non-Medicaid DCW Supplemental

FSR Bundle - Tab

Instructions

19

General Fund Contract Reconciliation and Cash Settlement

FSR Bundle - Tab

Instructions

20

General Fund Contract Settlement Worksheet

FSR Bundle - Tab

Instructions

21

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

FSR Bundle - Tab

Instructions

22

Financial Status Report - Certification Page

FSR Bundle - Tab

Instructions

23

Financial Status Report - Additional Narrative

FSR Bundle - Tab

24

Medicaid - Year End Accrual Schedule (Updated 9/20/2022)

Stand Alone Form

Instructions

25

General Fund - Year End Accrual Schedule (Updated 9/20/2022)

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

Stand Alone Form