FAC Explorer

Audit 54541

FY End
2022-06-30
Total Expended
$9.39M
Findings
4
Programs
13
Organization: Memorial Hospital of Laramie County D/b/a Cheyenne Regional Medical Ce (WY)
Year: 2022 Accepted: 2023-03-29
Auditor: Eide Bailly LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
59306 2022-001 Significant Deficiency - I
59307 2022-002 Significant Deficiency - L
635748 2022-001 Significant Deficiency - I
635749 2022-002 Significant Deficiency - L

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $4.33M Yes 0
93.461 Covid-19 Testing for the Uninsured $2.88M Yes 0
93.332 Cooperative Agreement to Support Navigators in Federally-Facilitated and State Partnership Marketplaces $951,063 Yes 2
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $369,465 - 0
16.575 Crime Victim Assistance $203,632 - 0
16.838 Comprehensive Opioid Abuse Site-Based Program $168,352 - 0
93.959 Block Grants for Prevention and Treatment of Substance Abuse $158,463 - 0
32.006 Covid-19 Telehealth Program $109,859 - 0
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $96,725 - 0
93.788 Opioid Str $83,388 - 0
93.387 National and State Tobacco Control Program (b) $16,924 - 0
93.969 Pphf Geriatric Education Centers $13,126 - 0
93.516 Affordable Care Act (aca) Public Health Training Centers Program $10,000 - 0

Contacts

Name Title Type
GZM7NGLXZNC4 Dawn Swaen Auditee
3076333075 Ashley Brandt-Duda Auditor
No contacts on file

Notes to SEFA

Title: Basis of Presentation Accounting Policies: Expenditures reported in the Schedule are reported on the accrual basis of accounting, with the exception for the COVID-19 Testing for the Uninsured program, which are recorded based on when the claim is deemed eligible as evidenced by the receipt of monies from the federal agency. When applicable, 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: Y Rate Explanation: The Medical Center has elected to use the 10% de minimis cost rate. The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of the Medical Center under programs of the federal government for the year ended June 30, 2022. The information is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations 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 Medical Center, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Medical Center.
Title: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Accounting Policies: Expenditures reported in the Schedule are reported on the accrual basis of accounting, with the exception for the COVID-19 Testing for the Uninsured program, which are recorded based on when the claim is deemed eligible as evidenced by the receipt of monies from the federal agency. When applicable, 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: Y Rate Explanation: The Medical Center has elected to use the 10% de minimis cost rate. The Medical Center received amounts from the U.S. Department of Health and Human Services (HHS) through the Provider Relief Fund and American Rescue Plan Rural Distribution (PRF) program (Federal Financial Assistance Listing #93.498) in the amount of $14,702,974 as of June 30, 2022. The PRF expenditures are not recognized on the Schedule until the expenditures are included in the reporting to HHS as required under the PRF program. The following summarizes the Provider Relief Funds and the timing of when the amounts were recognized in the financial statements. (see table in report). The total amount of PRF expenditures included on the Schedule requires management to make estimates and assumptions that affect the reported amounts. Accordingly, such expenditures are considered a significant estimate. Estimates and assumptions may include reducing actual expenses by amounts that have been reimbursed or are obligated to be reimbursed by other sources and estimating marginal increases in expenses related to coronavirus. Actual amounts could differ from those estimates

Finding Details

Finding 2022-001
2022-001 Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.332 Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges Procurement, Suspension, and Debarment Significant Deficiency in Internal Control over Compliance Criteria - Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires that a non-Federal entity must use its own documented procurement procedures which reflect applicable state and local laws and regulations, provided that the procurements conform to applicable federal law and standards. Condition ? Written procurement policies were not updated to conform to applicable standards under Uniform Guidance. Cause - The Medical Center did not have proper procedures to ensure its written procurement policies were updated to conform to the requirements identified in Uniform Guidance. Effect - The Medical Center did not have proper procedures to ensure its written procurement policies were updated to conform to the requirements identified in Uniform Guidance. Questioned Costs - None Reported. Context/Sampling - No sampling was performed as the procurement policy was examined in its entirety. Repeat Finding from Prior Year(s) ? No. Recommendation - We recommend the Medical Center ensure its written procurement policies are updated to conform to the requirements identified in Uniform Guidance. Views of Responsible Officials ? Management agrees with the finding.
Finding 2022-002
2022-002 Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.332 Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges Reporting Significant Deficiency in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: There was no evidence retained that the Medical Center?s compliance and financial reports submitted to the Department of Health and Human Services were reviewed and approved prior to submission. Cause: The Medical Center did not have an internal control policy in place to ensure documented review and approval of the compliance and financial reports. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs: None reported. Context: A nonstatistical sample of 13 out of 72 reports were selected for detail testing and did not include evidence of a review by someone other than the preparer. Repeat Finding from Prior Years: No Recommendation: We recommend that the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-001
2022-001 Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.332 Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges Procurement, Suspension, and Debarment Significant Deficiency in Internal Control over Compliance Criteria - Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires that a non-Federal entity must use its own documented procurement procedures which reflect applicable state and local laws and regulations, provided that the procurements conform to applicable federal law and standards. Condition ? Written procurement policies were not updated to conform to applicable standards under Uniform Guidance. Cause - The Medical Center did not have proper procedures to ensure its written procurement policies were updated to conform to the requirements identified in Uniform Guidance. Effect - The Medical Center did not have proper procedures to ensure its written procurement policies were updated to conform to the requirements identified in Uniform Guidance. Questioned Costs - None Reported. Context/Sampling - No sampling was performed as the procurement policy was examined in its entirety. Repeat Finding from Prior Year(s) ? No. Recommendation - We recommend the Medical Center ensure its written procurement policies are updated to conform to the requirements identified in Uniform Guidance. Views of Responsible Officials ? Management agrees with the finding.
Finding 2022-002
2022-002 Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.332 Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges Reporting Significant Deficiency in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: There was no evidence retained that the Medical Center?s compliance and financial reports submitted to the Department of Health and Human Services were reviewed and approved prior to submission. Cause: The Medical Center did not have an internal control policy in place to ensure documented review and approval of the compliance and financial reports. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs: None reported. Context: A nonstatistical sample of 13 out of 72 reports were selected for detail testing and did not include evidence of a review by someone other than the preparer. Repeat Finding from Prior Years: No Recommendation: We recommend that the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained. Views of Responsible Officials: Management agrees with the finding.