Information about Submitting Cost Reports

Uniform Account Report

Dear Hospice Licensee:

Under the authority of Arizona Revised Statutes §§ 36-125.04 and 36-436, the Department revised the rules in Arizona Administrative Code, Title 9, Chapter 11, to specify requirements for hospice agency financial reporting. The revised rules were approved by the Governor’s Regulatory Review Council and filed with the Secretary of State on October 2, 2007. The rules specifying requirements for hospice agency financial reports are available on the Secretary of State’s web site at: http://www.azsos.gov/public_services/Title_09/9-11.rtf. If you wish a courtesy hard copy of the Title 9, Chapter 11, rules please contact us.

These rules are effective on December 1, 2007.

There is one type of hospice financial report, the Hospice Uniform Accounting Report (UAR), required by the Department. The UAR is due 150 days after the hospice’s fiscal year end and should be sent to the Department as an e-mail attachment to the Cost Reporting staff listed below.

List of Hospice UAR Due Dates (XLS 34KB)

The Hospice UAR (see form and instructions below) will be posted on a schedule based on the facility’s fiscal year end date. Reports will be posted in March, June, and December. If a facility’s report is not received by the time of posting, there will be a blank space where the facility’s report should be posted.

A complete hospice UAR consists of:

• A Hospice Uniform Accounting Report Form [XLS 132KB], filled out with hospice-specific data;
  • Hospice Uniform Accounting Report Instructions [DOC 133 KB]
• A copy of the Hospice’s Medicare and Medicaid Cost Report – An e-mail copy of the report in PDF format is required.
• A Statement of Cash Flows.
• Attestation of Completeness and Accuracy Form [DOC 33K], completed by the hospice’s administrator.
  • Print and mail a hardcopy of the Attestation of Completeness and Accuracy to:
    
    Martha LaVoy, Financial Reporting Manager
    150 N. 18th Ave., Suite 550
    Phoenix, AZ 85007-3248