FAC Explorer

Audit 332070

FY End
2024-06-30
Total Expended
$52.44M
Findings
6
Programs
41
Organization: Cambridge Public Health Commission/cambridge Health Alliance (MA)
Year: 2024 Accepted: 2024-12-11
Auditor: Pricewaterhousecoopers LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
513898 2024-001 - - B
513899 2024-002 - - I
513900 2024-003 - - L
1090340 2024-001 - - B
1090341 2024-002 - - I
1090342 2024-003 - - L

Programs

ALN Program Spent Major Findings
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $31.13M Yes 0
93.493 Congressional Directives $4.63M Yes 2
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $4.27M - 0
93.495 Community Health Workers for Public Health Response and Resilient $1.11M - 0
93.104 Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances (sed) $928,395 - 0
93.788 Opioid Str $872,292 - 0
93.217 Family Planning Services $495,515 Yes 1
97.044 Assistance to Firefighters Grant $466,176 - 0
93.859 Biomedical Research and Research Training $464,952 - 0
16.575 Crime Victim Assistance $464,558 - 0
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $460,143 - 0
93.914 Hiv Emergency Relief Project Grants $356,249 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $262,887 - 0
93.213 Research and Training in Complementary and Integrative Health $198,263 - 0
21.027 Coronavirus State and Local Fiscal Recovery Funds $196,942 - 0
93.696 Certified Community Behavioral Health Clinic Expansion Grants $149,977 - 0
93.224 Community Health Centers $147,007 - 0
93.940 Hiv Prevention Activities Health Department Based $126,617 - 0
93.838 Lung Diseases Research $123,707 - 0
14.218 Community Development Block Grants/entitlement Grants $118,311 - 0
93.153 Coordinated Services and Access to Research for Women, Infants, Children, and Youth $112,435 - 0
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $96,850 - 0
93.186 National Research Service Award in Primary Care Medicine $92,514 - 0
93.191 Graduate Psychology Education $92,365 - 0
93.236 Grants to States to Support Oral Health Workforce Activities $85,000 - 0
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $72,521 - 0
93.959 Block Grants for Prevention and Treatment of Substance Abuse $60,000 - 0
93.958 Block Grants for Community Mental Health Services $54,494 - 0
93.U01 Harnessing Electronic Health Records to Enhance Reporting to the Vaccine Adverse Event Reporting System (vaers) $52,117 - 0
93.273 Alcohol Research Programs $50,268 - 0
93.242 Mental Health Research Grants $40,830 - 0
93.393 Cancer Cause and Prevention Research $39,261 - 0
93.121 Oral Diseases and Disorders Research $30,249 - 0
93.136 Injury Prevention and Control Research and State and Community Based Programs $23,643 - 0
93.866 Aging Research $19,644 - 0
93.161 Health Program for Toxic Substances and Disease Registry $18,714 - 0
93.307 Minority Health and Health Disparities Research $17,616 - 0
93.279 Drug Abuse and Addiction Research Programs $15,568 - 0
93.361 Nursing Research $14,534 - 0
66.034 Surveys, Studies, Research, Investigations, Demonstrations, and Special Purpose Activities Relating to the Clean Air Act $12,000 - 0
93.865 Child Health and Human Development Extramural Research $10,347 - 0

Contacts

Name Title Type
GCWMLMNVXKR3 Jill Batty Auditee
7812230332 Carol Ruiz Auditor
No contacts on file

Notes to SEFA

Title: Basis of Presentation Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the “Schedule”) includes the expenditures of Cambridge Health Alliance (the “Alliance”) under programs of the federal government for the year ended June 30, 2024. Expenditures reported in the Schedule are reported on the accrual basis of accounting. The information in this Schedule is presented in accordance with the requirements of the Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, some amounts presented in this Schedule may differ from amounts presented in, or used in the preparation of, the basic financial statements of the Alliance. Assistance listing numbers and pass-through award numbers are provided when available. The Schedule includes adjustments made to amounts reported in prior years in the normal course of business. For purposes of the Schedule, federal awards include all grants, contracts and similar agreements entered into directly by the Alliance with agencies and departments of the federal government and all subawards to the Alliance by nonfederal organizations pursuant to federal grants, contracts and similar agreements. De Minimis Rate Used: N Rate Explanation: The Alliance applies its predetermined approved facilities and administrative rate when charging indirect costs to federal awards rather than the 10% de minimis cost rate as described in Section 200.414 of the Uniform Guidance. The accompanying Schedule of Expenditures of Federal Awards (the “Schedule”) includes the expenditures of Cambridge Health Alliance (the “Alliance”) under programs of the federal government for the year ended June 30, 2024. Expenditures reported in the Schedule are reported on the accrual basis of accounting. The information in this Schedule is presented in accordance with the requirements of the Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, some amounts presented in this Schedule may differ from amounts presented in, or used in the preparation of, the basic financial statements of the Alliance. Assistance listing numbers and pass-through award numbers are provided when available. The Schedule includes adjustments made to amounts reported in prior years in the normal course of business. For purposes of the Schedule, federal awards include all grants, contracts and similar agreements entered into directly by the Alliance with agencies and departments of the federal government and all subawards to the Alliance by nonfederal organizations pursuant to federal grants, contracts and similar agreements.
Title: Indirect Cost Rate Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the “Schedule”) includes the expenditures of Cambridge Health Alliance (the “Alliance”) under programs of the federal government for the year ended June 30, 2024. Expenditures reported in the Schedule are reported on the accrual basis of accounting. The information in this Schedule is presented in accordance with the requirements of the Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, some amounts presented in this Schedule may differ from amounts presented in, or used in the preparation of, the basic financial statements of the Alliance. Assistance listing numbers and pass-through award numbers are provided when available. The Schedule includes adjustments made to amounts reported in prior years in the normal course of business. For purposes of the Schedule, federal awards include all grants, contracts and similar agreements entered into directly by the Alliance with agencies and departments of the federal government and all subawards to the Alliance by nonfederal organizations pursuant to federal grants, contracts and similar agreements. De Minimis Rate Used: N Rate Explanation: The Alliance applies its predetermined approved facilities and administrative rate when charging indirect costs to federal awards rather than the 10% de minimis cost rate as described in Section 200.414 of the Uniform Guidance. The Alliance applies its predetermined approved facilities and administrative rate when charging indirect costs to federal awards rather than the 10% de minimis cost rate as described in Section 200.414 of the Uniform Guidance.
Title: Women, Infants and Children (Assistance Listing Number 10.557) Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the “Schedule”) includes the expenditures of Cambridge Health Alliance (the “Alliance”) under programs of the federal government for the year ended June 30, 2024. Expenditures reported in the Schedule are reported on the accrual basis of accounting. The information in this Schedule is presented in accordance with the requirements of the Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, some amounts presented in this Schedule may differ from amounts presented in, or used in the preparation of, the basic financial statements of the Alliance. Assistance listing numbers and pass-through award numbers are provided when available. The Schedule includes adjustments made to amounts reported in prior years in the normal course of business. For purposes of the Schedule, federal awards include all grants, contracts and similar agreements entered into directly by the Alliance with agencies and departments of the federal government and all subawards to the Alliance by nonfederal organizations pursuant to federal grants, contracts and similar agreements. De Minimis Rate Used: N Rate Explanation: The Alliance applies its predetermined approved facilities and administrative rate when charging indirect costs to federal awards rather than the 10% de minimis cost rate as described in Section 200.414 of the Uniform Guidance. The Alliance determines participant eligibility for receipt of food vouchers as part of the Special Supplemental Nutrition Program for the Women, Infants and Children program (Assistance Listing # 10.557). Of the $4,266,455 in expenditures presented in the Schedule, $1,137,934 represents direct costs incurred by the Alliance for this program. The food vouchers for which the Alliance determined eligibility for amounted to $3,128,521 for the year ended June 30, 2024.
Title: Federal Emergency Management Agency Funds Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the “Schedule”) includes the expenditures of Cambridge Health Alliance (the “Alliance”) under programs of the federal government for the year ended June 30, 2024. Expenditures reported in the Schedule are reported on the accrual basis of accounting. The information in this Schedule is presented in accordance with the requirements of the Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, some amounts presented in this Schedule may differ from amounts presented in, or used in the preparation of, the basic financial statements of the Alliance. Assistance listing numbers and pass-through award numbers are provided when available. The Schedule includes adjustments made to amounts reported in prior years in the normal course of business. For purposes of the Schedule, federal awards include all grants, contracts and similar agreements entered into directly by the Alliance with agencies and departments of the federal government and all subawards to the Alliance by nonfederal organizations pursuant to federal grants, contracts and similar agreements. De Minimis Rate Used: N Rate Explanation: The Alliance applies its predetermined approved facilities and administrative rate when charging indirect costs to federal awards rather than the 10% de minimis cost rate as described in Section 200.414 of the Uniform Guidance. The Schedule includes grant activity related to the COVID-19 – Disaster Grants – Public Assistance (Presidentially Declared Disasters) FEMA Category B –Emergency Protective Measures 4496DR-MA funds Assistance Listing Number 97.036. As required based on the guidance in the 2024 OMB Compliance Supplement, the Schedule includes funds obligated between July 1, 2023 and June 30, 2024. The Schedule thus includes $31,125,016 of reportable amounts.

Finding Details

Finding 2024-001
2024 – 001 – Allowable costs/cost principles - Cost Transfers Grantor: Department of Health and Human Services Passthrough Agency: The Commonwealth of Massachusetts Department of Public Health Program Name: Family Planning – Services Project Grant (FPSPG) Award Name: Family Planning Services Award Year: 2024 Award Number: INTF3323MM3230133136 Assistance Listing Number: 93.217 Criteria The Department of Health and Human Services policy manual requires permissible cost transfers to be made promptly after the error occurs but no later than 90 days following the occurrence unless a longer period is approved in advance by the Grants Management Office. The Alliance’s Cost Transfer policy is to complete the Cost Transfer Explanation & Justification Form (“Form”) and to obtain the necessary approvals. The Form is required for cost transfers less than 90 days that are either (1) $500 or greater or (2) outside the accounting period (month). For cost transfers over 90 days, the Alliance must complete the Form including an explanation for the lateness of the transfer and obtain the approval by the Department Chairperson and the Director of Sponsored Research Administration. Condition Through our testing of the cost transfers over the Family Planning Services award, we selected three cost transfers. For each of the three selections, the entity did not complete the required Form and was not able to evidence that appropriate approval was obtained for the cost transfer. Cause For two of the samples that were processed within 90 days, the Alliance completed a hospital non-staffing reclass request form but did not complete a Cost Transfer Explanation & Justification Form as required. For the third sample relating to payroll reclasses for one individual over 90 days, no Form was completed. The individual completing the cost transfers was not aware of the Cost Transfer Explanation & Justification Form requirement. Effect The Alliance did not properly complete the Cost Transfer Explanation & Justification Form for the three samples. Although the cost transfers were deemed to be allowable, the Alliance did not retain any evidence that appropriate approvals were obtained. Questioned Costs There were no questioned costs associated with this finding as the cost transfers were allowable and allocable to the awards to which they were transferred. Recommendation The Alliance should implement training and communication to clarify their cost transfer policy over the Form and the required approvals. Management’s Views and Corrective Action Plan Please refer to the Alliance’s Management’s Views and Corrective Action Plan included at the end of this report for additional details.
Finding 2024-002
2024 – 002 – Procurement Grantor: Department of Health and Human Services Passthrough Agency: N/A Program Name: Community Project Funding/Congressionally Directed Spending - Construction Award Name: Congressional Directives Award Year: 2024 Award Number: 6 CE1HS47194-01-10 Assistance Listing Number: 93.493 Criteria 2 CFR 200.318(i) stipulates that non-Federal entities must maintain records sufficient to detail the history of procurement. These records should include, but are not necessarily limited to, the following: rationale for the method of procurement, selection of contract type, contractor selection or rejection, and the basis for the contract price. Condition The Alliance’s Procurement policy states that bidding is required for expenditures greater than $5,000. A minimum of two bids are required for any expenditures between $5,000 and $50,000 and a minimum of three bids are required for any expenditures greater than $50,000. The policy states that any purchase transactions above $25,000 are required to be approved by the head of the department. For two of the five samples selected for testing, the Alliance received the appropriate bids, but did not retain adequate documentation to support the basis for selecting the contractor. The Alliance did not retain documentation that the cost or price analysis was performed. Cause For the two samples, the individual completing the contractor selection process did not have the appropriate understanding that the basis for selecting the contractor was required to be formally documented or that the cost or price analysis was required to be formally documented and maintained. Effect Although the procurement policy was followed regarding the bidding process, no documentation was retained for the rationale regarding the selection of the contractor. Therefore, the Alliance was not in compliance with policy. Questioned Costs None noted. Recommendation The Alliance should implement training and communication to enforce their procurement policy over the bidding process including maintaining documentation of the decision between competing bids. Management’s Views and Corrective Action Plan Please refer to the Alliance’s Management’s Views and Corrective Action Plan included at the end of this report for additional details.
Finding 2024-003
2024 – 003 – Reporting Grantor: Department of Health and Human Services Passthrough Agency: N/A Program Name: Community Project Funding/Congressionally Directed Spending - Construction Award Name: Congressional Directives Award Year: 2024 Award Number: 6 CE1HS47194-01-10 Assistance Listing Number: 93.493 Criteria 2 CFR 200.328 requires non-Federal entities to submit financial reports as required by the Federal award. Condition Per the award agreement, the Federal Financial Report for the period of September 1, 2022 to August 31, 2023 was required to be submitted before January 30, 2024. Through our testing of the reporting over the Congressional Directives award, we selected the one Federal Financial Report (“FFR”) required to be issued in FY24, which was for the period of September 1, 2022 to August 31, 2023. For the one selection tested, the Alliance did not submit the Federal Financial Report prior to the due date of January 30, 2024. The Alliance could not provide additional supporting documentation indicating there was any pre-approval or acknowledgement for submitting reports late as is required per the award agreement. Cause For the selection tested, the Alliance noted that there was a delay in setting up an authorized employee with the appropriate system access due to the internal review requirements for new users. As the delay in receiving employee’s clearance continued, another Alliance employee (an approved analyst) filed the FFR on February 5, 2024, after being requested to do so. Effect The Alliance did not submit the FFR within the appropriate period per the award agreement, within the due date of January 30, 2024. Therefore, the Alliance was not in compliance with reporting requirements. Questioned Costs None noted. Recommendation The Alliance should ensure that timely submission of reports is performed as stated within agreed-upon award agreements with Department of Health and Human Services. Management’s Views and Corrective Action Plan Please refer to the Alliance’s Management’s Views and Corrective Action Plan included at the end of this report for additional details.
Finding 2024-001
2024 – 001 – Allowable costs/cost principles - Cost Transfers Grantor: Department of Health and Human Services Passthrough Agency: The Commonwealth of Massachusetts Department of Public Health Program Name: Family Planning – Services Project Grant (FPSPG) Award Name: Family Planning Services Award Year: 2024 Award Number: INTF3323MM3230133136 Assistance Listing Number: 93.217 Criteria The Department of Health and Human Services policy manual requires permissible cost transfers to be made promptly after the error occurs but no later than 90 days following the occurrence unless a longer period is approved in advance by the Grants Management Office. The Alliance’s Cost Transfer policy is to complete the Cost Transfer Explanation & Justification Form (“Form”) and to obtain the necessary approvals. The Form is required for cost transfers less than 90 days that are either (1) $500 or greater or (2) outside the accounting period (month). For cost transfers over 90 days, the Alliance must complete the Form including an explanation for the lateness of the transfer and obtain the approval by the Department Chairperson and the Director of Sponsored Research Administration. Condition Through our testing of the cost transfers over the Family Planning Services award, we selected three cost transfers. For each of the three selections, the entity did not complete the required Form and was not able to evidence that appropriate approval was obtained for the cost transfer. Cause For two of the samples that were processed within 90 days, the Alliance completed a hospital non-staffing reclass request form but did not complete a Cost Transfer Explanation & Justification Form as required. For the third sample relating to payroll reclasses for one individual over 90 days, no Form was completed. The individual completing the cost transfers was not aware of the Cost Transfer Explanation & Justification Form requirement. Effect The Alliance did not properly complete the Cost Transfer Explanation & Justification Form for the three samples. Although the cost transfers were deemed to be allowable, the Alliance did not retain any evidence that appropriate approvals were obtained. Questioned Costs There were no questioned costs associated with this finding as the cost transfers were allowable and allocable to the awards to which they were transferred. Recommendation The Alliance should implement training and communication to clarify their cost transfer policy over the Form and the required approvals. Management’s Views and Corrective Action Plan Please refer to the Alliance’s Management’s Views and Corrective Action Plan included at the end of this report for additional details.
Finding 2024-002
2024 – 002 – Procurement Grantor: Department of Health and Human Services Passthrough Agency: N/A Program Name: Community Project Funding/Congressionally Directed Spending - Construction Award Name: Congressional Directives Award Year: 2024 Award Number: 6 CE1HS47194-01-10 Assistance Listing Number: 93.493 Criteria 2 CFR 200.318(i) stipulates that non-Federal entities must maintain records sufficient to detail the history of procurement. These records should include, but are not necessarily limited to, the following: rationale for the method of procurement, selection of contract type, contractor selection or rejection, and the basis for the contract price. Condition The Alliance’s Procurement policy states that bidding is required for expenditures greater than $5,000. A minimum of two bids are required for any expenditures between $5,000 and $50,000 and a minimum of three bids are required for any expenditures greater than $50,000. The policy states that any purchase transactions above $25,000 are required to be approved by the head of the department. For two of the five samples selected for testing, the Alliance received the appropriate bids, but did not retain adequate documentation to support the basis for selecting the contractor. The Alliance did not retain documentation that the cost or price analysis was performed. Cause For the two samples, the individual completing the contractor selection process did not have the appropriate understanding that the basis for selecting the contractor was required to be formally documented or that the cost or price analysis was required to be formally documented and maintained. Effect Although the procurement policy was followed regarding the bidding process, no documentation was retained for the rationale regarding the selection of the contractor. Therefore, the Alliance was not in compliance with policy. Questioned Costs None noted. Recommendation The Alliance should implement training and communication to enforce their procurement policy over the bidding process including maintaining documentation of the decision between competing bids. Management’s Views and Corrective Action Plan Please refer to the Alliance’s Management’s Views and Corrective Action Plan included at the end of this report for additional details.
Finding 2024-003
2024 – 003 – Reporting Grantor: Department of Health and Human Services Passthrough Agency: N/A Program Name: Community Project Funding/Congressionally Directed Spending - Construction Award Name: Congressional Directives Award Year: 2024 Award Number: 6 CE1HS47194-01-10 Assistance Listing Number: 93.493 Criteria 2 CFR 200.328 requires non-Federal entities to submit financial reports as required by the Federal award. Condition Per the award agreement, the Federal Financial Report for the period of September 1, 2022 to August 31, 2023 was required to be submitted before January 30, 2024. Through our testing of the reporting over the Congressional Directives award, we selected the one Federal Financial Report (“FFR”) required to be issued in FY24, which was for the period of September 1, 2022 to August 31, 2023. For the one selection tested, the Alliance did not submit the Federal Financial Report prior to the due date of January 30, 2024. The Alliance could not provide additional supporting documentation indicating there was any pre-approval or acknowledgement for submitting reports late as is required per the award agreement. Cause For the selection tested, the Alliance noted that there was a delay in setting up an authorized employee with the appropriate system access due to the internal review requirements for new users. As the delay in receiving employee’s clearance continued, another Alliance employee (an approved analyst) filed the FFR on February 5, 2024, after being requested to do so. Effect The Alliance did not submit the FFR within the appropriate period per the award agreement, within the due date of January 30, 2024. Therefore, the Alliance was not in compliance with reporting requirements. Questioned Costs None noted. Recommendation The Alliance should ensure that timely submission of reports is performed as stated within agreed-upon award agreements with Department of Health and Human Services. Management’s Views and Corrective Action Plan Please refer to the Alliance’s Management’s Views and Corrective Action Plan included at the end of this report for additional details.