Audit 6569

2022-002 Sliding Fee Discount Determination CFDA Number: 93.224 Program: Community Health Center Cluster Compliance Requirement: (N) Special Tests and Provisions Criteria: Federal grant compliance provisions require that the Center correctly identify a patient's ability to pay and that the rates for services be adjusted accordingly based on the sliding fee schedule. The Center is required to follow its sliding fee policy when providing discounts to eligible patients. Finding/ Condition: In our sample of tested items, patient information was inadequate to determine the proper sliding fee discount or patients were given incorrect discounts based on information provided. Questioned Cost: None. Effect: Lack of strict enforcement of the policy of sliding fee eligibility determination and compliance may have resulted in the Center providing discounted services greater to or less than the appropriate amounts to beneficiaries. Cause: In the prior year the Center became aware of deficiencies in the sliding fee program through the annual external audit. By the time the deficiencies were reported there was not enough time to implement corrective actions for the current year. Thus, the same deficiencies were found in consecutive years. Repeat Finding: This is a repeat finding. Please see finding 2021-002. Recommendation: Training should be provided to employees on the sliding fee program requirements. Views of Responsible Officials and Corrective Action Plan: The Center agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan on page 35.

2022-003 Compliance Over Reporting ALN: 93.224 Program: Health Center Program Cluster Agency: US Department of Health and Human Services Compliance Requirement: (L) Reporting Repeat Finding: No Criteria: Pursuant to the reporting requirement set forth by the Department of Health and Human Services, the Center is required to submit the single audit to the federal audit clearinghouse within the sooner of 30 days of the issuance of the audit report or nine months after the end of the Center’s fiscal year-end. Finding/ Condition: During our reporting period, we noted that the audit was not completed and filed timely. Questioned Cost: None. Effect: The delay in submitting the required report may lead to the granting agency to impose temporary restrictions on the drawdown process. Cause: Staff shortages caused delay in the preparation for the audit. Recommendation: We recommend the Center file the year-end audit in a timely manner. Views of Responsible Officials and Corrective Action Plan: The Center agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan on page 35.

2022-004 Cash Management Compliance ALN: 93.834 Program: National Capacity Building Programs Agency: US Department of Health and Human Services Compliance Requirement: (C) Cash Management Repeat Finding: No Criteria: Non-Federal entities must minimize the time elapsing between the transfer of funds from the U.S. Treasury and disbursement by the non-Federal entity for program costs. Finding/ Condition: The Center made drawdowns of funds prior to incurring program expenditures. Questioned Cost: None. Effect: Early drawdowns create potential liabilities to the federal government and can affect future funding opportunities. Cause: Grant expenditures were not adequately tracked to be able to determine the proper amounts to drawdown. Recommendation: We recommend the Center improve the tracking of grant expenditures for all programs and then drawdown funds at month end based on the expenditures for the month. Views of Responsible Officials and Corrective Action Plan: The Center agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan on page 36.

2022-002 Sliding Fee Discount Determination CFDA Number: 93.224 Program: Community Health Center Cluster Compliance Requirement: (N) Special Tests and Provisions Criteria: Federal grant compliance provisions require that the Center correctly identify a patient's ability to pay and that the rates for services be adjusted accordingly based on the sliding fee schedule. The Center is required to follow its sliding fee policy when providing discounts to eligible patients. Finding/ Condition: In our sample of tested items, patient information was inadequate to determine the proper sliding fee discount or patients were given incorrect discounts based on information provided. Questioned Cost: None. Effect: Lack of strict enforcement of the policy of sliding fee eligibility determination and compliance may have resulted in the Center providing discounted services greater to or less than the appropriate amounts to beneficiaries. Cause: In the prior year the Center became aware of deficiencies in the sliding fee program through the annual external audit. By the time the deficiencies were reported there was not enough time to implement corrective actions for the current year. Thus, the same deficiencies were found in consecutive years. Repeat Finding: This is a repeat finding. Please see finding 2021-002. Recommendation: Training should be provided to employees on the sliding fee program requirements. Views of Responsible Officials and Corrective Action Plan: The Center agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan on page 35.

2022-003 Compliance Over Reporting ALN: 93.224 Program: Health Center Program Cluster Agency: US Department of Health and Human Services Compliance Requirement: (L) Reporting Repeat Finding: No Criteria: Pursuant to the reporting requirement set forth by the Department of Health and Human Services, the Center is required to submit the single audit to the federal audit clearinghouse within the sooner of 30 days of the issuance of the audit report or nine months after the end of the Center’s fiscal year-end. Finding/ Condition: During our reporting period, we noted that the audit was not completed and filed timely. Questioned Cost: None. Effect: The delay in submitting the required report may lead to the granting agency to impose temporary restrictions on the drawdown process. Cause: Staff shortages caused delay in the preparation for the audit. Recommendation: We recommend the Center file the year-end audit in a timely manner. Views of Responsible Officials and Corrective Action Plan: The Center agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan on page 35.

2022-004 Cash Management Compliance ALN: 93.834 Program: National Capacity Building Programs Agency: US Department of Health and Human Services Compliance Requirement: (C) Cash Management Repeat Finding: No Criteria: Non-Federal entities must minimize the time elapsing between the transfer of funds from the U.S. Treasury and disbursement by the non-Federal entity for program costs. Finding/ Condition: The Center made drawdowns of funds prior to incurring program expenditures. Questioned Cost: None. Effect: Early drawdowns create potential liabilities to the federal government and can affect future funding opportunities. Cause: Grant expenditures were not adequately tracked to be able to determine the proper amounts to drawdown. Recommendation: We recommend the Center improve the tracking of grant expenditures for all programs and then drawdown funds at month end based on the expenditures for the month. Views of Responsible Officials and Corrective Action Plan: The Center agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan on page 36.