Adult Care Facilities

2008-2009 Cost reports (click on high-lighted forms below to view or download)

• All reports are due December 31, 2009

Please print instructions for any of the applications below prior to downloading. Instructions are in Microsoft Word.
NOTE: If your application does not have a printer icon, hold down control + P to print.



1. Download this version if you already have Microsoft Access 2003 on your PC. If you have Microsoft Access 2007 proceed to Step #3. If you do not have Access at all or have Access 2000 or 2002 proceed to step #2. .
   Please print instructions before beginning download
   Click to download "Adult Care Cost Report application for Access 2003" (Updated 11/05/2009)



2. If you are using Microsoft Access 2007 to complete the cost reports.
   Please print instructions before beginning download.





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“NEW” Instructions for sending the Adult Care Cost Report to the Controller’s Office

This year we have new instructions on how to electronically file your cost report and what documentation needs to be sent to the Controller’s Office.
Please print instructions before beginning download.

• All Adult Care Homes with 7 or more beds must be audited this year.
  
  If your facility did NOT receive any State/County Special Assistance Funds and you DO NOT bill Medicaid PCS, you should submit an Exemption Form. DO NOT fill out a Cost Report.

Exemption Form - exem2009doc

• Adult Care Homes with 6 or less beds
  
  To obtain BLANK FORMS, download the appropriate "Adult Care Cost Report program". See link above. After downloading/installing application, click on "Print Report" button and follow the prompts.
  

  Instructions for Cost Report - instr609.doc

  DMA Cost Settlement Form - Go to the DMA website and then select "ACH-PCS Cost Settlements"

  Agreed Upon Procedures: NOT REQUIRED for 6 or less beds

  
  
• Adult Care Homes with 7 or more beds
  
  To obtain BLANK FORMS, download the "Adult Care Cost Report program " that you need. See the links above. After downloading application, click on "Print Report" button and follow the prompts.



Instructions for Cost Report - instr709.doc

DMA PCS Cost Settlement Form - Go to the DMA website and then select "ACH-PCS Cost Settlements"

Agreed Upon Procedures: for 7 or more beds

• Accountants Certification Form



• Adult Care Facilities
• Attachment I, II & III



• Special Care Units
• Attachment I, II & III



• Mental Health Facilities
• Attachment I, II & III



• Nursing Facilities
• Attachment I

Contact people below if you have questions/problems: