Cost Reporting and Review
Home Health Agency (HHA) Financial Reporting
All reports/documents must be submitted as email attachments to the Department's Cost Reporting Program: firstname.lastname@example.org.
Required reporting is comprised of the following:
- Home Health Agency Rates and Charges Form (available below)
- Attestation of Completeness and Accuracy (available below)
- Home Health Agency Rates & Charges
As a prerequisite to operations, Arizona law requires all home health agencies to submit a Rates and Charges Package as specified under Arizona Administrative Code R9-11-304 to the Department prior to providing services to patients. Arizona law also requires all home health agencies to keep their current rates and charges on file with the Department. To meet the intent of the law, the completed HHA Rates and Charges Form and Attestation of Completeness and Accuracy must be submitted annually on the anniversary of the HHA’s previous submission.
- Rates and Charges: HHA-9999_CCYYMM_RC
- Rates and Charges Attestation: HHA-9999_CCYYMM_ATT-RC
- HHA-9999 = your facility license number; i.e. HHA-1234
- CCYYMM = the year/month you are reporting to the Department; i.e. 201504
The requirements for this reporting are found in Arizona Administrative Code, Title 9, Chapter 11, available on the Arizona Secretary of State's web site.