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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. There Are No Filing Extensions For Reporting Of Uar/mcr. The completed UAR form, Medicare Cost Report copy in PDF format and Attestation of Completeness and Accuracy must be submitted together.
    • Uniform Accounting Report: HSPC-9999_CCYYMM_FYCCYY_UAR
    • Uniform Accounting Report - Supplemental: HSPC-9999_CCYYMM_FYCCYY_UAR-SUPP
    • Medicare Cost Report: HSPC-9999_CCYYMM_FYCCYY_MCR
    • UAR Attestation: HSPC-9999_CCYYMM_FYCCYY_ATT-UAR
      • 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.