Adult Care Facilities

2007-2008 Cost reports (click on high-lighted forms below to view or download)

• All reports are due December 31, 2008

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 on your PC .
   (Not compatable with Access 97 or older)
   Please print instructions before beginning download
   Click to download "Adult Care Cost Report application for Access 2002". (1MG self-extracting file)



2. Adult Care Cost Report Runtime Application Download
   (The Runtime Application is required for anyone not using one of the following versions of Access: 2007, 2003, 2002 ( also know as XP), or 2000)
   **Print these instructions before beginning download.**
   Once the runtime application download has been installed, continue to Step #1 above.
   **CAUTION: do not attempt to download the Runtime Application without having a HIGH SPEED INTERNET CONNECTION.**
   



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




• All Adult Care Homes with 21 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 - exem2008.doc

• 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 - instr608.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 - instr708.doc

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

Agreed Upon Procedures: for 21 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

NC Office of the Controller Home Page

NC Department of Health and Human Services

North Carolina Home Page

Last updated December 17, 2008