Ariz. Admin. Code § R9-11-204 - Nursing Care Institution Uniform Accounting Report

A. A nursing care institution administrator or designee shall submit a uniform accounting report to the Department, in a format specified by the Department, no later than 150 calendar days after the ending date of the nursing care institution's fiscal year.

B. A nursing care institution administrator or designee shall submit a copy of the nursing care institution's Medicare cost report, if applicable, as part of the uniform accounting report required in subsection (A).

C. The uniform accounting report required in subsection (A) shall include the following information:

1. The name, physical address, mailing address, county, and telephone number of the nursing care institution;

2. The name, physical address, mailing address, and telephone number of the nursing care institution's:

a. Home office, if applicable; and

b. Management company, if applicable;

3. An alternative name under which the nursing care institution provides nursing services or health-related services, if applicable;

4. The identification number assigned to the nursing care institution:

a. By the Department;

b. By AHCCCS, if applicable;

c. By Medicare, if applicable; and

d. As the nursing care institution's national provider identifier;

5. The name, telephone number, and e-mail address of the:

a. Nursing care institution administrator;

b. Nursing care institution chief financial officer;

c. Individual who prepared the uniform accounting report; and

d. Individual whom the Department may contact about the uniform accounting report at the:

i. Home office, if applicable; and

ii. Management company, if applicable;

6. The beginning and ending dates of the nursing care institution's reporting period;

7. If the nursing care institution began operations during the nursing care institution's reporting period, the date on which the nursing care institution began operations;

8. The date the uniform accounting report was submitted to the Department;

9. Whether the entity that is the owner of the nursing care institution is:

a. Not for profit;

b. For profit; or

c. A federal, state, or local government agency;

10. Whether or not the nursing care institution is Medicare-certified;

11. The licensed capacity at the beginning and end of the reporting period;

12. The total number of available beds at the beginning and end of the reporting period;

13. If the nursing care institution has a distinct unit for patients whose payer source is Medicare, the number of licensed beds in that unit at the beginning and end of the reporting period;

14. The number of resident admissions during the reporting period;

15. The number of resident days during the reporting period:

a. For each payer source that is not ALTCS, and

b. For each level of care for residents whose payer source is ALTCS;

16. The total number of resident days during the reporting period;

17. The average occupancy rate for the reporting period;

18. The number of paid hours during the reporting period for each of the following types of employees:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

19. The number of hours worked during the reporting period by each of the following types of employees:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

20. The amount in salaries paid, excluding employee-related expenses, for each of the following types of employees:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

21. The number of each of the following types of employees at the beginning of the reporting period:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

22. The number of each of the following types of employees at the end of the reporting period:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

23. For staff employed by the nursing care institution during the reporting period as registered nurses, practical nurses, or certified nursing assistants, the total:

a. Number of paid hours;

b. Number of hours worked;

c. Amount in salaries paid, excluding employee-related expenses;

d. Number of staff at the beginning of the reporting period; and

e. Number of staff at the end of the reporting period;

24. The turnover rate for the reporting period for:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

25. The total turnover rate for the reporting period for all employees of the nursing care institution who are registered nurses, practical nurses, or certified nursing assistants;

26. The number of hours worked during the reporting period by each of the following types of contracted workers:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

27. The total number of hours worked during the reporting period by contracted workers who are registered nurses, practical nurses, or certified nursing assistants;

28. The amount paid during the reporting period for each of the following types of contracted workers:

a. Registered nurses,

b. Practical nurses, and

c. Certified nursing assistants;

29. The total amount paid during the reporting period to contracted workers who are registered nurses, practical nurses, or certified nursing assistants;

30. The amount of revenue generated and allowances given, for each type of revenue or allowance, by the nursing care institution during the reporting period;

31. The total amount of revenue generated and allowances given by the nursing care institution during the reporting period;

32. The operating expenses incurred by the nursing care institution during the reporting period for each type of operating expense;

33. The total operating expenses incurred by the nursing care institution during the reporting period;

34. The income and expenses, other than revenue and operating expenses, for each type of income received and expense incurred by the nursing care institution during the reporting period;

35. The charges for non-covered ancillary services during the reporting period:

a. For each type of non-covered ancillary service,

b. For each type of payer source, and

c. For each type of non-covered ancillary service for each type of payer source;

36. The total amount of non-covered ancillary charges for the reporting period;

37. If the nursing care institution has documentation of building improvement costs that:

a. Affected the licensed capacity:

i. The year in which each building improvement was completed;

ii. The cost of each building improvement;

iii. The licensed capacity before the building improvement was begun;

iv. The number of beds that were added as a result of the building improvement, if applicable;

v. The number of beds that were removed as a result of the building improvement, if applicable; and

vi. The licensed capacity after the building improvement was completed; and

b. Did not affect the licensed capacity:

i. The year in which each building improvement was completed; and

ii. The cost of each building improvement;

38. The amount of assets, for each type of asset, of the nursing care institution at the end of the reporting period;

39. The total amount of assets of the nursing care institution at the end of the reporting period;

40. The amount of liabilities, for each type of liability, of the nursing care institution at the end of the reporting period;

41. The total amount of liabilities of the nursing care institution at the end of the reporting period;

42. The amount of equity, for each type of equity, of the nursing care institution at the end of the reporting period;

43. The total amount of equity of the nursing care institution at the end of the reporting period;

44. The difference between the amount identified in subsection (C)(43) and the amount identified in subsection (C)(41); and

45. An equity reconciliation statement, including:

a. Net equity at the beginning of the reporting period;

b. The difference between the amount identified in subsection (C)(31) and the amount identified in subsection (C)(33);

c. Additions to equity, for each type of additional equity, for the reporting period;

d. The total amount of additional equity for the reporting period;

e. Deductions from equity, for each type of equity deduction, for the reporting period;

f. The total amount of equity deduction for the reporting period; and

g. Net equity at the end of the reporting period.

D. A nursing care institution administrator or designee shall:

1. On a form provided by the Department:

a. Attest that, to the best of the knowledge and belief of the nursing care institution administrator or designee, the information submitted according to subsections (B) and (C) is accurate and complete; or

b. If the nursing care institution administrator or designee has personal knowledge that the information submitted according to subsections (B) and (C) is not accurate or not complete:

i. Identify the information that is not accurate or not complete;

ii. Describe the circumstances that make the information not accurate or not complete;

iii. State what actions the nursing care institution is taking to correct the inaccurate information or make the information complete; and

iv . Attest that, to the best of the knowledge and belief of the nursing care institution administrator or designee, the information submitted according to subsections (B) and (C), except the information identified in subsection (D)(1)(b)(i), is accurate and complete; and

2. Submit the form specified in subsection (D)(1) as part of the uniform accounting report required in subsection (A).

E. A nursing care institution administrator who receives a request from the Department for revision of a uniform accounting report not prepared according to subsections (B), (C), and (D) shall ensure that the revised uniform accounting report is submitted to the Department:

1. Within 21 calendar days after the date on the Department's letter requesting an initial revision, and

2. Within seven calendar days after the date on the Department's letter requesting a second revision.

F. If a nursing care institution administrator or designee does not submit a uniform accounting report according to this Section, the Department may assess civil penalties as specified in A.R.S. § 36-126.

Notes

Ariz. Admin. Code § R9-11-204

New Section made by final rulemaking at 13 A.A.R. 3648, effective December 1, 2007 (Supp. 07-4).