Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-002 - Accuracy of Reporting to the PRF Portal: U.S. Department of Health and Human Services, COVID-19: Provider Relief Fund and American Rescue Plan ("ARP") Rural Distribution: Assistance Listing Number 93.498 - Reporting (Material Weakness)
Criteria:
The Coronavirus Aid, Relief, and Economic Security ("CARES") Act and American Rescue Plan ("ARP") Act of 2021 appropriated funds to reimburse eligible healthcare providers for health care related expenses or lost revenues attributable to COVID-19. These funds were distributed by Health Resources and Services Administration ("HRSA"). HRSA developed the Provider Relief Fund ("PRF") Reporting Portal to enable PRF and ARP Rural recipients to comply with mandatory reporting requirements.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the Organization's submission to the PRF Portal included inconsistencies with the underlying supporting accounting records.
Cause:
Due to the timing of the completion of the audit and the portal report submission deadline, certain audit-related adjustments were not included in the report submitted to the PRF portal.
Effect:
The Organization's report in the PRF portal does not agree to the underlying supporting accounting records.
Questioned costs:
None
Context:
Although there were inconsistencies between the actual revenue amounts reported in the PRF portal and the underlying supporting accounting records, the Organization had an adequate amount of lost revenue to earn the PRF funding received.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that the Organization strengthen its system of internal controls to ensure that all reporting that is done and submitted is consistent with requirements and instructions as provided by regulatory agencies.
Management response:
Management is in agreement with the audit finding that the PRF portal submission was not consistent with the underlying supporting accounting records. Measures will be taken to implement controls that will ensure that reports are reviewed and agreed to supporting underlying accounting records before they are submitted.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-001 - Implementation of Sliding Fee Scale Policy: U.S. Department of Health and Human Services, Health Center Program Cluster: Assistance Listing Number 93.224/93.527 - Special Tests and Provisions (Significant Deficiency)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254 b requires Health Centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Community Health Project, Inc.'s policy requires that the board of directors and the Executive Director review the fee structure annually.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the board of directors did not review and approve the 2023 sliding fee scale.
Cause:
Due to transition in management, the review of the sliding fee scale was not included among the agenda items for the board meeting.
Effect:
Failure in implementing one of the internal control procedures over the sliding fee scale may lead to errors and non-compliance of the sliding fee scale to certain federal poverty guidelines.
Questioned costs:
None
Context:
The board did not review and approve the sliding fee scale before it was implemented in February 2023.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that management implement their policy that requires board review and approval of the sliding fee scale in a consistent manner. The approval of the sliding fee scale should be added to the agenda items as a recurring annual matter to help ensure that it is completed. We recommend further that the employee/s in charge of inputting the sliding fee scale into the electronic medical record ("EMR") system obtain evidence of board approval of the sliding fee scale before it is coded into the EMR.
Management response:
Management is in agreement with the audit finding that the sliding fee scale was not presented to the board of directors for review. However, the board reviewed the sliding fee scale during their meeting in February 2024 and did not find any error in the sliding fee scale and they retroactively approved and authorized its application from February 2023 to February 2024. Measures will be taken to ensure that the sliding fee scale is presented on a yearly basis to the board of directors for their review and that such review is documented.
Item 2023-002 - Accuracy of Reporting to the PRF Portal: U.S. Department of Health and Human Services, COVID-19: Provider Relief Fund and American Rescue Plan ("ARP") Rural Distribution: Assistance Listing Number 93.498 - Reporting (Material Weakness)
Criteria:
The Coronavirus Aid, Relief, and Economic Security ("CARES") Act and American Rescue Plan ("ARP") Act of 2021 appropriated funds to reimburse eligible healthcare providers for health care related expenses or lost revenues attributable to COVID-19. These funds were distributed by Health Resources and Services Administration ("HRSA"). HRSA developed the Provider Relief Fund ("PRF") Reporting Portal to enable PRF and ARP Rural recipients to comply with mandatory reporting requirements.
Statement of Condition:
During our audit of the year ended June 30, 2023, we noted that the Organization's submission to the PRF Portal included inconsistencies with the underlying supporting accounting records.
Cause:
Due to the timing of the completion of the audit and the portal report submission deadline, certain audit-related adjustments were not included in the report submitted to the PRF portal.
Effect:
The Organization's report in the PRF portal does not agree to the underlying supporting accounting records.
Questioned costs:
None
Context:
Although there were inconsistencies between the actual revenue amounts reported in the PRF portal and the underlying supporting accounting records, the Organization had an adequate amount of lost revenue to earn the PRF funding received.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that the Organization strengthen its system of internal controls to ensure that all reporting that is done and submitted is consistent with requirements and instructions as provided by regulatory agencies.
Management response:
Management is in agreement with the audit finding that the PRF portal submission was not consistent with the underlying supporting accounting records. Measures will be taken to implement controls that will ensure that reports are reviewed and agreed to supporting underlying accounting records before they are submitted.