Ariz. Admin. Code § R9-11-205 - Hospice Uniform Accounting Report

A. A hospice administrator or designee shall submit a uniform accounting report to the Department, in a format specified by the Department, within 150 calendar days after the end of the hospice's fiscal year.

B. A hospice administrator or designee shall submit a copy of the hospice's Medicare and Medicaid cost reports, 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 hospice;

2. The identification number assigned to the hospice:

a. By the Department;

b. By AHCCCS, if applicable;

c. By Medicare, if applicable; and

d. As the hospice's national provider identifier;

3. The beginning and ending dates of the hospice's reporting period;

4. If the hospice began operations during the hospice's reporting period, the date on which the hospice began operations;

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

a. Hospice administrator,

b. Hospice chief financial officer, and

c. Individual who prepared the uniform accounting report;

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

7. Whether the hospice operates as a:

a. Hospice service agency, or

b. Hospice service agency with one or more hospice inpatient facilities;

8. Whether the entity that is the owner of the hospice is:

a. Not for profit;

b. For profit; or

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

9. Whether or not the hospice is Medicare-certified;

10. The entity by which the hospice is accredited, if applicable;

11. Whether the hospice provides hospice services in an area that:

a. Is equal to or more than two-thirds urban,

b. Is equal to or more than two-thirds rural, or

c. Is less than two-thirds urban and less than two-thirds rural;

12. Whether the hospice is:

a. Free-standing,

b. A hospital-based hospice,

c. A nursing care institution-based hospice,

d. An assisted living facility-based hospice, or

e. A home health agency-based hospice;

13. 12. If the hospice operates one or more hospice inpatient facilities, list for each hospice inpatient facility:

a. The identification number assigned to the hospice inpatient facility by the Department;

b. Whether the hospice inpatient facility is:

i. Located within a hospital;

ii. Located within a nursing care institution;

iii. Located within an assisted living facility; or

iv. Not located within a hospital, nursing care institution, or assisted living facility;

c. b. The levels of care provided;

d. c. The licensed capacity of the hospice inpatient facility;

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

f. e. The average occupancy rate for the reporting period;

14. 13. The number of patients during the reporting period that were:

a. Referred to the hospice,

b. Admitted to the hospice,

c. Died while admitted to the hospice, and

d. Discharged from the hospice while living;

15. 14. The number of patient care days, for all patients, during the reporting period in which the hospice provided:

a. Routine home care,

b. Respite care services,

c. Continuous care, and

d. Inpatient services;

16. 15. The total number of patient care days during the reporting period for all patients;

17. 16. The average daily census for the reporting period, calculated as the number specified in subsection (C)(15) divided by the number of days in the reporting period;

18.17. Average length of stay, calculated as the number of patient care days for patients discharged during the reporting period divided by the sum of the numbers specified in subsections (C)(13)(c) and (C)(13)(d);

19. 18. Median length of stay for patients discharged during the reporting period;

20. 19. The number of patients admitted to the hospice during the reporting period:

a. By gender;

b. By age group;

c. By race and ethnicity;

d. From:

i. A private home owned or leased by, or on behalf of, a patient;

ii. An assisted living facility;

iii. A nursing care institution;

iv. A hospital; and

v. A hospice;

e. With a principal diagnosis of:

i. Cancer,

ii. Heart disease,

iii. Dementia,

iv. Lung disease,

v. Kidney disease,

vi. Stroke or coma,

vii. Liver disease,

viii. HIV-related disease,

ix. Motor neuron disorder,

x. Unspecified debility, and

xi. A disease not specified in subsections (C)(19)(e)(i) through (C)(19)(e)(x); and

f. Whose payer source is:

i. Medicare,

ii. AHCCCS,

iii. Self-pay,

iv. A private insurance company, and

v. A payer source not specified in subsections (C)(19)(f)(i) through (C)(19)(f)(iv);

21. 20. The total number of patient care days during the reporting period that the hospice provided hospice services to a patient whose principal diagnosis was related to:

a. Cancer,

b. Heart disease,

c. Dementia,

d. Lung disease,

e. Kidney disease,

f. Stroke or Coma,

g. Liver disease,

h. HIV-related disease,

i. Motor neuron disorder,

j. Unspecified debility, and

k. Any other disease not specified in subsections (C)(20)(a) through (C)(20)(j);

22. 21. The number of FTEs providing hospice services, for each type of employee, during the reporting period;

23. 22. The total number of FTEs providing hospice services during the reporting period;

24. 23. The average caseload during the reporting period for a licensed nurse, calculated as the total number of patients assigned to licensed nurses working for the hospice during the reporting period, divided by the total number of licensed nurses working for the hospice during the reporting period, for:

a. Outpatient hospice services, and

b. Hospice services provided in hospice inpatient facilities;

25. 24. The average caseload during the reporting period for a social worker, calculated as the total number of patients assigned to social workers working for the hospice during the reporting period, divided by the total number of social workers working for the hospice during the reporting period, for:

a. Outpatient hospice services, and

b. Hospice services provided in hospice inpatient facilities;

26. 25. The average caseload during the reporting period for nursing personnel other than a licensed nurse, calculated as the total number of patients assigned to nursing personnel other than licensed nurses working for the hospice during the reporting period, divided by the total number of nursing personnel other than licensed nurses working for the hospice during the reporting period, for:

a. Outpatient hospice services, and

b. Hospice services provided in hospice inpatient facilities;

27. 26. The average caseload during the reporting period for a chaplain, calculated as the total number of patients assigned to chaplains working for the hospice during the reporting period, divided by the total number of chaplains working for the hospice during the reporting period, for:

a. Outpatient hospice services, and

b. Hospice services provided in hospice inpatient facilities;

28. 27. The number of individuals who received bereavement services from the hospice during the reporting period;

29. 28. The number of individuals from the hospice who provided bereavement services during the reporting period;

30. 29. The total number of volunteers during the reporting period;

31. 30. The total number of hours that volunteers provided hospice services during the reporting period;

32. 31. The number of patient care days during the reporting period, for whom:

a. The payer source was:

i. Medicare,

ii. AHCCCS,

iii. Self-pay,

iv. A private insurance company, and

v. A payer source not specified in subsections (C)(31)(a)(i) through (C)(31)(a)(iv), and

b. There was no payer source identified;

33. 32. The total number of patient care days specified in subsection (C)(31);

34. 33. The total amount of money billed, during the reporting period to:

a. Medicare,

b. AHCCCS,

c. Self-pay,

d. A private insurance company, and

e. A payer source not specified in subsections (C)(33)(a) through (C)(33)(d);

35. 34. The total amount of money billed during the reporting period;

36. 35. The amount of revenue generated, for each type of revenue, by the hospice during the reporting period;

37. 36. The amount of allowances given, for each type of allowance, by the hospice during the reporting period;

38. 37. The total amount of revenue generated and allowances given by the hospice during the reporting period;

39. 38. The operating expenses incurred, for each type of operating expense, by the hospice during the reporting period;

40. 39. The total operating expenses incurred by the hospice during the reporting period;

41. 40. The difference between the amount identified in subsection (C)(37) and the amount identified in subsection (C)(39);

42. 41. The income and expenses, other than revenue and operating expenses, for each type of income received and expense incurred by the hospice during the reporting period;

43. 42. The amount of assets, for each type of asset, of the hospice at the end of the reporting period;

44. 43. The total amount of assets of the hospice at the end of the reporting period;

45. 44. The amount of liabilities, for each type of liability, of the hospice at the end of the reporting period;

46. 45. The total amount of liabilities of the hospice at the end of the reporting period;

47. 46. The amount of net assets, for each type of net asset, of the hospice at the end of the reporting period;

48. 47. The total amount of net assets of the hospice at the end of the reporting period;

49. 48. The difference between the amount identified in subsection (C)(47) and the amount identified in subsection (C)(45); and

50. 49. The statement of cash flows required in A.R.S. § 36-125.04(C)(3).

D. A hospice 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 hospice administrator or designee, the information submitted according to subsections (B) and (C) is accurate and complete; or

b. If the hospice 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 hospice 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 hospice 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 hospice 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 hospice 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 § R9-11-205

New Section made by final rulemaking at 13 A.A.R. 3648, effective December 1, 2007 (Supp. 07-4). Amended by final rulemaking at 28 A.A.R. 1481, effective 11/7/2022.