MedicaidAdministrativeHigh impact
MSA 17-46
Michigan Medicaid - MDHHS·MI · Palliative Care·Provider Bulletin
Effective date
Jan 2, 2018
We identified it
Jun 20, 2026
Summary
Michigan Medicaid is implementing a new electronic system (CHAMPS MCC) that requires hospice, nursing facilities, hospitals, PACE and MI Choice providers to enter admissions and discharges directly in the system instead of using paper forms. Several paper forms including MSA-2565-C, DCH-1074, MSA-0814, and MSA-0815 will no longer be accepted after December 15, 2017.
Action Required
By December 15, 2017: Stop using paper forms MSA-2565-C (for admissions), DCH-1074 (Hospice Membership Notice), MSA-0814 (MI Choice Enrollment), and MSA-0815 (MI Choice Disenrollment). By January 2, 2018: Begin entering all admissions and discharges directly in the CHAMPS system electronically. Print and obtain required signatures on system-generated forms for patient records. Check the Member Enrollment/Admission List screen for accuracy and make corrections as needed. Failure to transition to electronic system will result in forms not being processed by MDHHS.