FAC Explorer

Audit 5270

FY End
2022-04-30
Total Expended
$13.71M
Findings
4
Programs
30
Organization: Bighorn Valley Health Center, Inc. (WA)
Year: 2022 Accepted: 2023-12-05
Auditor: Cliftonlarsonallen LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
3376 2022-004 Significant Deficiency Yes N
3377 2022-004 Significant Deficiency Yes N
579818 2022-004 Significant Deficiency Yes N
579819 2022-004 Significant Deficiency Yes N

Programs

ALN Program Spent Major Findings
93.527 Grant for New and Expanded Services Under Health Cener Program $5.24M Yes 1
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $1.86M Yes 1
93.498 Covid-19: Provider Relief Fund $1.29M Yes 0
93.224 Covid-19: American Rescue Plan Act Funding for Health Centers $1.06M Yes 0
32.006 Covid-19 Telehealth Program $877,500 Yes 0
93.526 Grants for Capital Development in Health Centers $610,528 Yes 0
93.211 Telehealth Programs $420,785 - 0
93.788 Opioid Str $406,796 - 0
93.224 Covid-19: Health Center Coronavirus Aid, Relief, and Economic Security (cares) Act Funding $277,191 Yes 0
93.217 Family Planning Services $260,224 - 0
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $214,334 - 0
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance - Treatment for Pregnant and Postpartum Women $163,677 - 0
93.912 Covid-19: Rural Tribal Covid-19 Response $132,973 - 0
66.818 Brownfields Multipurpose, Assessment Revolving Loan Fund and Cleanup Cooperative Agreements $121,157 - 0
93.870 Maternal, Infant and Early Childhood Home Visiting Grant - Health Montana Families $120,810 - 0
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $116,166 - 0
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $97,998 - 0
93.069 Public Health Emergency Preparedness $86,778 - 0
93.136 Injury Prevention and Control Research and State and Community Based Programs: Cdc Overdose Data to Action Communities That Care (ctc) Communities That Care (ctc) $55,933 - 0
93.958 Block Grants for Community Mental Health Services $54,461 - 0
93.110 Maternal and Child Health Federal Consolidated Programs $35,642 - 0
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $33,674 - 0
93.268 Immunization Cooperative Agreements $28,625 - 0
93.224 Covid-19: Fy 2020 Expanding Capacity for Coronavirus Testing (ect) $27,786 Yes 0
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance - Communities That Care $25,418 - 0
93.236 Grants to States to Support Oral Health Workforce Activities $13,081 - 0
93.994 Maternal and Child Health Services Block Grant to the States $10,868 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $7,093 - 0
93.426 Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke $3,564 - 0
93.435 Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke $2,950 - 0

Contacts

Name Title Type
GALQGCNCE367 Dr. David Mark Auditee
4066293015 Kyla Delgado 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 the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. Negative amounts shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. De Minimis Rate Used: N Rate Explanation: One Health has not elected to use the 10% de minimis indirect cost rate as allowed under the Uniform Guidance. The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Bighorn Valley Health Center, Inc. dba: One Health (One Health) under programs of the federal government for the year ended April 30, 2022. The information in this Schedule is presented in accordance with the requirements of 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of the One Health, it is not intended to and does not present the financial position, statements of activities and changes in net assets, functional expenses, or cash flows of the One Health.
Title: FINANCIAL STATEMENT REVENUE 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 the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. Negative amounts shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. De Minimis Rate Used: N Rate Explanation: One Health has not elected to use the 10% de minimis indirect cost rate as allowed under the Uniform Guidance. The consolidated financial statements for the year ended April 30, 2022 reflect revenue recognized from the Provider Relief Fund (PRF) of $1,090,921 which includes $906,962 and $183,959 received during PRF reporting periods 1 and 4, respectively. The financial statements for the year ended April 30, 2021 reflect revenue recognized from the PRF of $379,945 all of which was received during PRF reporting period 1. In accordance with the requirement of the compliance supplement for assistance listing number 93.498, the SEFA includes $1,286,907 of PRF which was received during PRF reporting period.

Finding Details

Finding 2022-004
Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS24102-10 Award Period: May 1, 2021 through April 30, 2022 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance. Criteria or Specific Requirement: 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 patient’s ability to pay. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition: The organization had assessed four patients with the incorrect sliding fee discount; three patients were assessed a lower discount and one patient was assessed a higher discount based on their family size and income information that was documented. Questioned Costs: None. Context: For 4 of the 25 sliding fee encounters tested, the sliding fee discount applied to the encounter did not match the sliding fee application provided. Cause: There was no process to review sliding fee discounts applied to patient balances prior to finalizing them. Effect: Applicants assessed are not charged according to the Organization's sliding fee scale and their ability to pay. Repeat Finding: Yes – repeat of 2021-001. Recommendation: Management should consider increasing the frequency of its internal audits over patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the collection and verification of patient information for each patient. Views of responsible officials: There is no disagreement with the audit findings.
Finding 2022-004
Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS24102-10 Award Period: May 1, 2021 through April 30, 2022 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance. Criteria or Specific Requirement: 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 patient’s ability to pay. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition: The organization had assessed four patients with the incorrect sliding fee discount; three patients were assessed a lower discount and one patient was assessed a higher discount based on their family size and income information that was documented. Questioned Costs: None. Context: For 4 of the 25 sliding fee encounters tested, the sliding fee discount applied to the encounter did not match the sliding fee application provided. Cause: There was no process to review sliding fee discounts applied to patient balances prior to finalizing them. Effect: Applicants assessed are not charged according to the Organization's sliding fee scale and their ability to pay. Repeat Finding: Yes – repeat of 2021-001. Recommendation: Management should consider increasing the frequency of its internal audits over patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the collection and verification of patient information for each patient. Views of responsible officials: There is no disagreement with the audit findings.
Finding 2022-004
Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS24102-10 Award Period: May 1, 2021 through April 30, 2022 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance. Criteria or Specific Requirement: 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 patient’s ability to pay. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition: The organization had assessed four patients with the incorrect sliding fee discount; three patients were assessed a lower discount and one patient was assessed a higher discount based on their family size and income information that was documented. Questioned Costs: None. Context: For 4 of the 25 sliding fee encounters tested, the sliding fee discount applied to the encounter did not match the sliding fee application provided. Cause: There was no process to review sliding fee discounts applied to patient balances prior to finalizing them. Effect: Applicants assessed are not charged according to the Organization's sliding fee scale and their ability to pay. Repeat Finding: Yes – repeat of 2021-001. Recommendation: Management should consider increasing the frequency of its internal audits over patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the collection and verification of patient information for each patient. Views of responsible officials: There is no disagreement with the audit findings.
Finding 2022-004
Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS24102-10 Award Period: May 1, 2021 through April 30, 2022 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance. Criteria or Specific Requirement: 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 patient’s ability to pay. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition: The organization had assessed four patients with the incorrect sliding fee discount; three patients were assessed a lower discount and one patient was assessed a higher discount based on their family size and income information that was documented. Questioned Costs: None. Context: For 4 of the 25 sliding fee encounters tested, the sliding fee discount applied to the encounter did not match the sliding fee application provided. Cause: There was no process to review sliding fee discounts applied to patient balances prior to finalizing them. Effect: Applicants assessed are not charged according to the Organization's sliding fee scale and their ability to pay. Repeat Finding: Yes – repeat of 2021-001. Recommendation: Management should consider increasing the frequency of its internal audits over patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the collection and verification of patient information for each patient. Views of responsible officials: There is no disagreement with the audit findings.