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Cost Reporting and Review

Nursing Care Institutions

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 Nursing Care Institution state UAR form (available below)
    2. Medicare Cost Report (MCR) copy
    3. Statement of Cash Flow
  2. Nursing Care Institution Rates and Charges Form (available below)
  3. Attestation of Completeness and Accuracy specific to reporting type (available below)
Reporting Instructions:
  1. Uniform Accounting Report (UAR)
    The UAR is due 150 days after the nursing care institution’s fiscal year end. The completed UAR form, Medicare Cost Report copy in PDF format, Statement of Cash Flow and Attestation of Completeness and Accuracy must be submitted together. Name your above document files as follows:
    • Uniform Accounting Report: NCI-9999_CCYYMM_FYCCYY_UAR.xls
    • Medicare Cost Report: NCI-9999_CCYYMM_FYCCYY_MCR.pdf
    • UAR Attestation: NCI-9999_CCYYMM_FYCCYY_ATT-UAR.pdf
      • NCI-9999 = your facility license number; i.e. NCI-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
  2. Nursing Care Institution Rates & Charges
    As a prerequisite to operations, Arizona law requires all nursing care institutions to submit a Rates and Charges Package as specified under Arizona Administrative Code R9-11-303 to the Department prior to providing services to patients. Arizona law also requires all nursing care institutions to keep their current rates and charges on file with the Department. To meet the intent of the law, the completed NCI Rates and Charges Form and applicable Attestation of Completeness and Accuracy must be submitted annually at the same time the nursing care institution’s other financial reporting documents (as described on this page) are due to the Department. Name your above document files as follows:
    • Rates and Charges: NCI-9999_CCYYMM_RC.xls
      • NCI-9999 = your facility license number; i.e. NCI-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.