Long Term Care Resources (NFs and ICF/IIDs) FCP and FRV Forms
Facility Cost Profile (FCP) Forms
These forms are necessary for nursing home providers to meet reporting requirements. Please use the 2026 forms. Old forms/spreadsheets will be returned.
NF Nursing Homes
For FCP NF FY26 forms and instructions, contact David Meadows at [email protected].
ICF/IID Nursing Homes
For FCP ICF/IID FY26 forms and instructions, contact David Meadows at [email protected].
Fair Rental Value (FRV) Data Report Forms
Reminder: This report is optional. If submitted, it must be received no later than the first business day in March.
Failure to do so will preclude the data from being considered. (No extensions will be granted.)
Please be sure to carefully read and follow the instructions.
Questions should be directed to
email David Meadows
(contact information is on the bottom of this page)
Long-Term Care Resources (NFs and ICFs/ID) |
Please click on one of the following links to be directed to specific resources available for that category: Nursing Facilities - MDS Case Mix Preview Report - UPL QI Program |
Contact Information
FCP and FRV Questions | Via U.S. Post Office | Via UPS or FedEx |
801-538-6790 | Utah Deparment of Health and Human Services Division of Integrated Healthcare Office of Reimbursement, Coordinated Care, and Audit David Meadows PO Box 143104 Salt Lake City, UT 84114-3108 | Utah Deparment of Health and Human Services Division of Integrated Healthcare Office of Reimbursement, Coordinated Care, and Audit 288 North 1460 West Salt Lake City, UT 84116-3231 |
If you are unsure about an issue, please ask questions.