Audit 836

Provider Relief Fund and American Rescue Plan Act (ARP) Rural Distribution Federal Assistance Listing No. 93.498 U.S. Department of Health and Human Services Criteria or Specific Requirement – Reporting (45 CFR 75.342) and Activities Allowed/Unallowed and Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623) Condition – The Organization is required to prepare and submit period four Provider Relief Funding Reporting. This report is to be prepared using accurate financial information and submitted by the deadline established. Questioned Costs – Unknown Context – The period four Provider Relief Fund report was tested. The Organization selected option three to report lost revenues based on quarterly actual results of the dental and pediatrics service lines. The Organization did not account for the Iowa Medicaid wraparound payments within the 2020, 2021, and 2022 quarters. After including these amounts in a subsequent evaluation, the Organization was able to demonstrate the error did not affect its ability to fully obligate the distributions received based on the proposed methodology. Effect – The lost revenue reported did not fully reflect the Organization’s activities within the dental and pediatric service lines. Cause – Nine of fifteen attributes tested that disclose lost revenues for the dental and pediatric service lines were inconsistent with the audited financial results of those service lines. Identification As a Repeat Finding – Repeat finding 2022-001. Recommendation - The Organization should revise its internal allocation processes, specifically the Iowa Medicaid wrap payment mechanism, to ensure activity is fully and accurately reported across departments and activities at the health center.

Provider Relief Fund and American Rescue Plan Act (ARP) Rural Distribution Federal Assistance Listing No. 93.498 U.S. Department of Health and Human Services Criteria or Specific Requirement – Reporting (45 CFR 75.342) and Activities Allowed/Unallowed and Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623) Condition – The Organization is required to prepare and submit period four Provider Relief Funding Reporting. This report is to be prepared using accurate financial information and submitted by the deadline established. Questioned Costs – Unknown Context – The period four Provider Relief Fund report was tested. The Organization selected option three to report lost revenues based on quarterly actual results of the dental and pediatrics service lines. The Organization did not account for the Iowa Medicaid wraparound payments within the 2020, 2021, and 2022 quarters. After including these amounts in a subsequent evaluation, the Organization was able to demonstrate the error did not affect its ability to fully obligate the distributions received based on the proposed methodology. Effect – The lost revenue reported did not fully reflect the Organization’s activities within the dental and pediatric service lines. Cause – Nine of fifteen attributes tested that disclose lost revenues for the dental and pediatric service lines were inconsistent with the audited financial results of those service lines. Identification As a Repeat Finding – Repeat finding 2022-001. Recommendation - The Organization should revise its internal allocation processes, specifically the Iowa Medicaid wrap payment mechanism, to ensure activity is fully and accurately reported across departments and activities at the health center.