MedicaidAdministrativeHigh impact
MSA 17-33
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
Dec 15, 2017
We identified it
Jun 20, 2026
Summary
Michigan is eliminating paper Facility Admission Notice forms (MSA-2565-C) for most admissions effective December 15, 2017, with providers required to enter admissions/discharges directly into CHAMPS system starting January 2, 2018. The paper form will only be accepted for newborns when hospitals cannot use the Electronic Birth Certificate system.
Action Required
By December 15, 2017: Stop submitting paper MSA-2565-C forms for facility admissions except newborns when unable to use Electronic Birth Certificate system. By January 2, 2018: Hospice, hospital, nursing facility, MI Choice Waiver and PACE providers must enter all admissions/enrollments and discharge/disenrollments directly into CHAMPS system instead of using paper forms.