Audit 328955

FY End
2023-04-30
Total Expended
$12.49M
Findings
6
Programs
27
Year: 2023 Accepted: 2024-11-19
Auditor: Dza PLLC

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
508355 2023-001 Significant Deficiency Yes N
508356 2023-001 Significant Deficiency Yes N
508357 2023-001 Significant Deficiency Yes N
1084797 2023-001 Significant Deficiency Yes N
1084798 2023-001 Significant Deficiency Yes N
1084799 2023-001 Significant Deficiency Yes N

Programs

ALN Program Spent Major Findings
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $5.54M Yes 1
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $825,034 Yes 1
93.211 Telehealth Programs $662,923 - 0
93.788 Opioid Str $439,280 - 0
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $184,588 - 0
93.498 Provider Relief Fund $183,959 - 0
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $141,655 - 0
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $134,022 - 0
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $129,854 - 0
93.959 Block Grants for Prevention and Treatment of Substance Abuse $125,214 - 0
66.818 Brownfields Assessment and Cleanup Cooperative Agreements $123,821 - 0
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $105,339 - 0
93.870 Maternal, Infant and Early Childhood Home Visiting Grant $96,349 - 0
93.069 Public Health Emergency Preparedness $96,251 - 0
93.217 Family Planning_services $93,206 - 0
21.027 Coronavirus State and Local Fiscal Recovery Funds $89,250 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $75,036 - 0
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $39,959 - 0
93.110 Maternal and Child Health Federal Consolidated Programs $35,174 - 0
93.944 Human Immunodeficiency Virus (hiv)/acquired Immunodeficiency Virus Syndrome (aids) Surveillance $17,084 - 0
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $16,169 - 0
93.236 Grants to States to Support Oral Health Workforce Activities $14,719 - 0
93.994 Maternal and Child Health Services Block Grant to the States $14,100 - 0
93.268 Immunization Cooperative Agreements $13,319 - 0
93.435 Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke- $7,050 - 0
93.136 Injury Prevention and Control Research and State and Community Based Programs $5,867 - 0
93.958 Block Grants for Community Mental Health Services $4,251 - 0

Contacts

Name Title Type
GALQGCNCE367 Emily Faricy Auditee
4066654103 Shaun Johnson Auditor
No contacts on file

Notes to SEFA

Title: Basis of Presentation Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in accordance with the Uniform Guidance wherein certain types of expenditures are not allowable or are limited as to reimbursement. Therefore, some amounts presented in this Schedule may differ from amounts presented, or used in the preparation of, the consolidated financial statements. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Bighorn Valley Health Center, Inc., doing business as One Health and Subsidiary (the Organization) under programs of the federal government for the year ended April 30, 2023. Amounts reported on the Schedule for Federal Assistance Listing number 93.498 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution are based upon the December 31, 2022, Provider Relief Fund report. The information in this Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a selected portion of the operations of the Organization, it is not intended to, and does not, present the financial position, changes in net assets, or cash flows of the Organization.
Title: De Minimis Inderect Cost Rate Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in accordance with the Uniform Guidance wherein certain types of expenditures are not allowable or are limited as to reimbursement. Therefore, some amounts presented in this Schedule may differ from amounts presented, or used in the preparation of, the consolidated financial statements. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. During the year ended April 30, 2023, the Organization did not elect to use the 10 percent de minimis indirect cost rate allowed under the Uniform Guidance related to federal grants, due to differing funder requirements.

Finding Details

Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS24102, H8FCS41012, H8GCS47827, H2ECS45503, H2ECS45503 Criteria: Compliance Finding and Significant Deficiency Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients ability to pay.” Condition: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three incidents in which the incorrect sliding fee was applied. Context: This finding appears to be an isolated incident. A sample size of 25 patients included three which did not have the correct sliding fee applied. Cause: The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: Patients may have been granted the incorrect sliding fee discount. Questioned Costs: None identified Recommendation:We recommend continued effort in training personnel to properly identify and apply the appropriate sliding fee discount based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action: Management does not disagree with this audit finding.
Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS24102, H8FCS41012, H8GCS47827, H2ECS45503, H2ECS45503 Criteria: Compliance Finding and Significant Deficiency Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients ability to pay.” Condition: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three incidents in which the incorrect sliding fee was applied. Context: This finding appears to be an isolated incident. A sample size of 25 patients included three which did not have the correct sliding fee applied. Cause: The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: Patients may have been granted the incorrect sliding fee discount. Questioned Costs: None identified Recommendation:We recommend continued effort in training personnel to properly identify and apply the appropriate sliding fee discount based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action: Management does not disagree with this audit finding.
Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS24102, H8FCS41012, H8GCS47827, H2ECS45503, H2ECS45503 Criteria: Compliance Finding and Significant Deficiency Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients ability to pay.” Condition: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three incidents in which the incorrect sliding fee was applied. Context: This finding appears to be an isolated incident. A sample size of 25 patients included three which did not have the correct sliding fee applied. Cause: The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: Patients may have been granted the incorrect sliding fee discount. Questioned Costs: None identified Recommendation:We recommend continued effort in training personnel to properly identify and apply the appropriate sliding fee discount based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action: Management does not disagree with this audit finding.
Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS24102, H8FCS41012, H8GCS47827, H2ECS45503, H2ECS45503 Criteria: Compliance Finding and Significant Deficiency Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients ability to pay.” Condition: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three incidents in which the incorrect sliding fee was applied. Context: This finding appears to be an isolated incident. A sample size of 25 patients included three which did not have the correct sliding fee applied. Cause: The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: Patients may have been granted the incorrect sliding fee discount. Questioned Costs: None identified Recommendation:We recommend continued effort in training personnel to properly identify and apply the appropriate sliding fee discount based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action: Management does not disagree with this audit finding.
Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS24102, H8FCS41012, H8GCS47827, H2ECS45503, H2ECS45503 Criteria: Compliance Finding and Significant Deficiency Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients ability to pay.” Condition: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three incidents in which the incorrect sliding fee was applied. Context: This finding appears to be an isolated incident. A sample size of 25 patients included three which did not have the correct sliding fee applied. Cause: The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: Patients may have been granted the incorrect sliding fee discount. Questioned Costs: None identified Recommendation:We recommend continued effort in training personnel to properly identify and apply the appropriate sliding fee discount based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action: Management does not disagree with this audit finding.
Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS24102, H8FCS41012, H8GCS47827, H2ECS45503, H2ECS45503 Criteria: Compliance Finding and Significant Deficiency Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients ability to pay.” Condition: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three incidents in which the incorrect sliding fee was applied. Context: This finding appears to be an isolated incident. A sample size of 25 patients included three which did not have the correct sliding fee applied. Cause: The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: Patients may have been granted the incorrect sliding fee discount. Questioned Costs: None identified Recommendation:We recommend continued effort in training personnel to properly identify and apply the appropriate sliding fee discount based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action: Management does not disagree with this audit finding.