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 R9-11-204 - Nursing Care Institution Uniform Accounting Report

Current through Register Vol. 30, No. 28, July 12, 2024
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.