Hospitals – Effective December 1, 2007

Information about Submitting Cost Reports

Prior Year UAR Reports

Cost Comparison Report

Information about Submitting Cost Reports
Dear Hospital 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 hospital 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 hospital financial reporting 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 are three types of hospital financial reports required by the Department. All reports are to be submitted to the Department as e-mail attachments to the Cost Reporting staff listed below.

List of Hospital Report Due Dates [XLS 42K]

1. A Copy of the Hospital's Annual Audited Financial Statement (AFS):  The AFS is due 120 days after the hospital’s fiscal year end.  A 30-day extension may be requested from our office (see contact information below).  An electronic copy of the AFS in PDF format is preferred.
   
   
   • The AFS must be from an independent certified public accountant.
   • If a hospital is part of a group, a combined AFS will be acceptable IF the AFS contains a financial statement specific to the hospital.
     
     
2. The Hospital Uniform Accounting Report (UAR): The UAR is due 150 days after the hospital’s fiscal year end.

The Hospital UAR (see forms 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 Hospital UAR consists of:

• A Hospital Uniform Accounting Report Form [XLS 111KB], filled out with hospital-specific data.
• Hospital Uniform Accounting Report Instructions [DOC 90KB]
• A copy of the Hospital’s Medicare Cost Report - An e-mail copy of the report in PDF format is required.
• A Statement of Cash Flow, unless submitted as part of the annual Audited Financial Statement.
• Attestation of Completeness and Accuracy [DOC 35K], completed by the hospital’s administrator.
  • Print and mail a hard copy of the Attestation of Completeness and Accuracy to:

  Martha LaVoy, Financial Reporting Manager
  150 N. 18th Ave., Suite 550
  Phoenix, AZ  85007-3248

3. Hospital Chargemaster and the Rates & Charges Overview Form.  All hospitals are required to keep their existing schedule of rates and charges on file with the Department.
   
   
   • The Charge Description Master (CDM), or chargemaster, is a comprehensive listing of items that could be billed to a patient, payer, or healthcare provider.
   • If a facility submits changes to its CDM that affect the Rates & Charges Overview Form, the facility must also submit an updated Rates & Charges Overview Form.

The Office policy will be to receive a complete current chargemaster, including CPT Codes, a new Rates & Charges Overview Form, and a completed Attestation of Completeness and Accuracy from each hospital at the beginning of each calendar quarter.

• Rates & Charges Overview Form [XLS 39K]
• Rates & Charges Overview Data Dictionary [XLS 42K]
• Attestation of Completeness and Accuracy [DOC 35K]
  • Print and mail a hard copy of the Attestation of Completeness and Accuracy to:

  Martha LaVoy, Financial Reporting Manager
  150 N. 18th Ave., Suite 550
  Phoenix, AZ  85007-3248

                                                                     Contacts

Prior Year Uniform Accounting Reports

2008 UAR 2007 UAR 2006 UAR 2005 UAR 2004 UAR

Cost Comparison Report

2009 Rates and Charges Comparison Report by County

2008 & 2009 Rates & Charges Comparison Report

2007 Rates & Charges Comparison Report

2006 Rates & Charges Comparison Report