Audit 324954

2024-001 Other Matter – Sliding Fee Adjustments Information of Federal Programs U.S. Department of Health and Human Services – Health Center Programs (Direct) AL# 93.224 U.S. Department of Health and Human Services – Grants for New and Expanded Services under the Health Center Programs (Direct) AL# 93.527 Criteria – Section 42 USC 254b(K)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR section 56.303(e), (f), and (g) requires that health centers provide discounted fees for individuals and families with incomes above 100% and at or below 200% of the federal poverty guidelines. Condition – Instances were noted where the sliding fee adjustments were applied incorrectly. Cause – Isolated cases where unusual circumstances applied to the visit and the manual adjustments made were done incorrectly. Effect or Potential Effect – Sliding fee discounts were not appropriately calculated. Questioned Costs – None noted. Context – Of the 40 visits we selected for testing we noted the following errors on 3 individual visits: - State vaccine program provided adjustments for specific vaccines provided to the patient, however, the sliding fee adjustment to reduce the remaining balance below the minimal fee for health center visits. Patients did not overpay for services – 2 visits noted. - Updated FPL and SpectraPlan schedules caused a patient to change levels mid-year and SpectraPlan levels in the billing module did not update. Patient received slide at a lower level than appropriate – 1 visit noted. Repeat Finding – This is not a repeat finding. Recommendation –Additional training of billers on application of federal/state reimbursement charges and policies in place for review of SpectraPlan levels when FPL guidelines are updated.

2024-001 Other Matter – Sliding Fee Adjustments Information of Federal Programs U.S. Department of Health and Human Services – Health Center Programs (Direct) AL# 93.224 U.S. Department of Health and Human Services – Grants for New and Expanded Services under the Health Center Programs (Direct) AL# 93.527 Criteria – Section 42 USC 254b(K)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR section 56.303(e), (f), and (g) requires that health centers provide discounted fees for individuals and families with incomes above 100% and at or below 200% of the federal poverty guidelines. Condition – Instances were noted where the sliding fee adjustments were applied incorrectly. Cause – Isolated cases where unusual circumstances applied to the visit and the manual adjustments made were done incorrectly. Effect or Potential Effect – Sliding fee discounts were not appropriately calculated. Questioned Costs – None noted. Context – Of the 40 visits we selected for testing we noted the following errors on 3 individual visits: - State vaccine program provided adjustments for specific vaccines provided to the patient, however, the sliding fee adjustment to reduce the remaining balance below the minimal fee for health center visits. Patients did not overpay for services – 2 visits noted. - Updated FPL and SpectraPlan schedules caused a patient to change levels mid-year and SpectraPlan levels in the billing module did not update. Patient received slide at a lower level than appropriate – 1 visit noted. Repeat Finding – This is not a repeat finding. Recommendation –Additional training of billers on application of federal/state reimbursement charges and policies in place for review of SpectraPlan levels when FPL guidelines are updated.

2024-001 Other Matter – Sliding Fee Adjustments Information of Federal Programs U.S. Department of Health and Human Services – Health Center Programs (Direct) AL# 93.224 U.S. Department of Health and Human Services – Grants for New and Expanded Services under the Health Center Programs (Direct) AL# 93.527 Criteria – Section 42 USC 254b(K)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR section 56.303(e), (f), and (g) requires that health centers provide discounted fees for individuals and families with incomes above 100% and at or below 200% of the federal poverty guidelines. Condition – Instances were noted where the sliding fee adjustments were applied incorrectly. Cause – Isolated cases where unusual circumstances applied to the visit and the manual adjustments made were done incorrectly. Effect or Potential Effect – Sliding fee discounts were not appropriately calculated. Questioned Costs – None noted. Context – Of the 40 visits we selected for testing we noted the following errors on 3 individual visits: - State vaccine program provided adjustments for specific vaccines provided to the patient, however, the sliding fee adjustment to reduce the remaining balance below the minimal fee for health center visits. Patients did not overpay for services – 2 visits noted. - Updated FPL and SpectraPlan schedules caused a patient to change levels mid-year and SpectraPlan levels in the billing module did not update. Patient received slide at a lower level than appropriate – 1 visit noted. Repeat Finding – This is not a repeat finding. Recommendation –Additional training of billers on application of federal/state reimbursement charges and policies in place for review of SpectraPlan levels when FPL guidelines are updated.

2024-001 Other Matter – Sliding Fee Adjustments Information of Federal Programs U.S. Department of Health and Human Services – Health Center Programs (Direct) AL# 93.224 U.S. Department of Health and Human Services – Grants for New and Expanded Services under the Health Center Programs (Direct) AL# 93.527 Criteria – Section 42 USC 254b(K)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR section 56.303(e), (f), and (g) requires that health centers provide discounted fees for individuals and families with incomes above 100% and at or below 200% of the federal poverty guidelines. Condition – Instances were noted where the sliding fee adjustments were applied incorrectly. Cause – Isolated cases where unusual circumstances applied to the visit and the manual adjustments made were done incorrectly. Effect or Potential Effect – Sliding fee discounts were not appropriately calculated. Questioned Costs – None noted. Context – Of the 40 visits we selected for testing we noted the following errors on 3 individual visits: - State vaccine program provided adjustments for specific vaccines provided to the patient, however, the sliding fee adjustment to reduce the remaining balance below the minimal fee for health center visits. Patients did not overpay for services – 2 visits noted. - Updated FPL and SpectraPlan schedules caused a patient to change levels mid-year and SpectraPlan levels in the billing module did not update. Patient received slide at a lower level than appropriate – 1 visit noted. Repeat Finding – This is not a repeat finding. Recommendation –Additional training of billers on application of federal/state reimbursement charges and policies in place for review of SpectraPlan levels when FPL guidelines are updated.