Cost Reporting and Review

Hospice Financial Reporting

ALL REPORTS/DOCUMENTS MUST BE SUBMITTED AS EMAIL ATTACHMENTS to the Department's Cost Reporting Program: costreporting@azdhs.gov.

Required reporting is comprised of the following:
  1. Uniform Accounting Report (UAR) which includes:
    1. Arizona Hospice state UAR form (available below)
    2. Medicare Cost Report (MCR) copy
    3. Statement of Cash Flow
  2. Attestation of Completeness and Accuracy (available below)
Reporting Instructions:
  • Uniform Accounting Report (UAR)
    The UAR is due 150 days after the hospice’s fiscal year end. The completed UAR form, Medicare Cost Reportcopy in PDF format, Statement of Cash Flow, and Attestation of Completeness and Accuracy must be submitted together.
    • Uniform Accounting Report: HSPC-9999_CCYYMM_FYCCYY_UAR.xls
    • Medicare Cost Report: HSPC-9999_CCYYMM_FYCCYY_MCR.pdf
    • UAR Attestation: HSPC-9999_CCYYMM_FYCCYY_ATT-UAR.pdf
      • HSPC-9999 = your facility license number; i.e. HSPC-1234
      • CCYYMM = the year/month you are reporting to the Department; i.e. 201504
      • FYCCYY = the facility fiscal year of this reporting; i.e. FY2014

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.