Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 11 - DEPARTMENT OF HEALTH SERVICES - HEALTH CARE INSTITUTION FACILITY AND HEALTH PROFESSIONALS WORKFORCE DATA › Article 2 - ANNUAL FINANCIAL STATEMENTS AND UNIFORM ACCOUNTING REPORTS › Section R9-11-205 - Hospice Uniform Accounting Report

Current through Register Vol. 30, No. 28, July 12, 2024
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. 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. The levels of care provided;
c. The
				licensed capacity of the hospice inpatient facility;
d. The total number of
				available beds at the beginning and end of the reporting period; and
e. The
				average occupancy rate for the reporting period;
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;
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;
15. The total number of patient care days during the
				reporting period for all patients;
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;
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);
18. Median length of
				stay for patients discharged during the reporting period;
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);
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);
21. The number of FTEs
				providing hospice services, for each type of employee, during the reporting
				period;
22. The total number of FTEs providing hospice
				services during the reporting period;
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;
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;
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;
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;
27.
				The number of individuals who received bereavement services from the hospice
				during the reporting period;
28. The number of
				individuals from the hospice who provided bereavement services during the
				reporting period;
29. The total number of volunteers during the
				reporting period;
30. The total number of hours that volunteers provided
				hospice services during the reporting period;
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;
32. The total number
				of patient care days specified in subsection (C)(31);
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);
34. The total amount
				of money billed during the reporting period;
35. The amount of
				revenue generated, for each type of revenue, by the hospice during the
				reporting period;
36. The amount of allowances given, for each type of
				allowance, by the hospice during the reporting period;
37.
				The total amount of revenue generated and allowances given by the hospice
				during the reporting period;
38. The operating
				expenses incurred, for each type of operating expense, by the hospice during
				the reporting period;
39. The total
				operating expenses incurred by the hospice during the reporting
				period;
40. The difference between the amount identified in
				subsection (C)(37) and the amount identified in subsection (C)(39);
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;
42. The amount of assets, for each type of asset, of
				the hospice at the end of the reporting period;
43. The total amount
				of assets of the hospice at the end of the reporting period;
44.
				The amount of liabilities, for each type of liability, of the hospice at the
				end of the reporting period;
45. The total amount
				of liabilities of the hospice at the end of the reporting period;
46.
				The amount of net assets, for each type of net asset, of the hospice at the end
				of the reporting period;
47. The total amount
				of net assets of the hospice at the end of the reporting period;
48.
				The difference between the amount identified in subsection (C)(47) and the
				amount identified in subsection (C)(45); and
49. The statement of
				cash flows required in A.R.S. §
										36-125.04(C)(3).