Corrective Action Plans

Finding 51420 (2022-001)

Significant Deficiency 2022

MD

Subrecipient Monitoring Internal Control / Segregation of Duties

The Board acknowledges the value of an audit/monitoring function. However, as a result of budget constraints, the Board does not plan to implement in internal audit/monitoring function.

View Audit 51497

Finding 51410 (2022-001)

Significant Deficiency 2022

Lane Manor Rhf Housing, Inc. Dba Lane Manor 061-Ee166

CA

Questioned Costs Subrecipient Monitoring HUD Housing Programs

Statement of Condition 2022-001 (Assistance Listing 14.157): During the year ended September 30, 2022, the Corporation paid expenses totaling $4,565 on behalf of an affiliated entity without HUD approval. Recommendation: The affiliated entity should repay $4,565 to the Corporation. Management Resp...

Statement of Condition 2022-001 (Assistance Listing 14.157): During the year ended September 30, 2022, the Corporation paid expenses totaling $4,565 on behalf of an affiliated entity without HUD approval. Recommendation: The affiliated entity should repay $4,565 to the Corporation. Management Response: Agree. The affiliated entity repaid the Corporation $4,565 on October 25, 2022.

View Audit 42068 Questioned Costs: $1

Finding 51408 (2022-005)

Material Weakness 2022

Ramsey County

MN

Questioned Costs Allowable Costs / Cost Principles Subrecipient Monitoring

Finding Number: 2022-005 Finding Title: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Program: 21.023 COVID-19 ? Emergency Rental Assistance Program Name of Contact Person Responsible for Corrective Action: Tara Bach, Director Operational Support Services Corrective Action Plan...

Finding Number: 2022-005 Finding Title: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Program: 21.023 COVID-19 ? Emergency Rental Assistance Program Name of Contact Person Responsible for Corrective Action: Tara Bach, Director Operational Support Services Corrective Action Planned: ? The County will request supporting documentation, including general ledger report and/or bank statements and client list, to verify that advance payment have been spent before dispersing additional advance payments to subrecipient. ? Make sure extra time is given when moving expenses between grants to ensure that nothing gets moved twice. Anticipated Completion Date: The process used for this change has been implemented effective June 15, 2023.

View Audit 51214 Questioned Costs: $1

Finding 51405 (2022-004)

Material Weakness 2022

Ramsey County

MN

Subrecipient Monitoring Allowable Costs / Cost Principles Cash Management

Finding Number: 2022-004 Finding Title: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Program: 14.231 Emergency Solutions Grant Program Name of Contact Person Responsible for Corrective Action: George Hardgrove, EGCI Service Team Controller Corrective Action Planned: Ramsey Cou...

Finding Number: 2022-004 Finding Title: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Program: 14.231 Emergency Solutions Grant Program Name of Contact Person Responsible for Corrective Action: George Hardgrove, EGCI Service Team Controller Corrective Action Planned: Ramsey County had exceptions for 6 of 40 transactions tested. The exceptions noted were for a lack of receipt copies and not having the proper payroll reports attached. We agree with the lack of receipt copies. For payroll, we felt the payroll reports provided were adequate to determine the appropriate labor cost. The receipt issue came to about 2.5% of the $5.5M that was expended under this award in 2022 while the payroll documentation was about 7% of this amount. Nonetheless, we will create and use a check list to ensure we have the proper receipt copies and payroll reports for each subrecipient invoice we approve. We will also work on clarifying the required payroll reports with our grantors. Anticipated Completion Date: December 31, 2023.

View Audit 51214

Finding 51403 (2022-001)

Significant Deficiency 2022

The District of Columbia Bar Foundation

DC

Procurement, Suspension & Debarment Subrecipient Monitoring

Identifying Number: 2022-001 Finding: Procurement Corrective Action Taken: DCBF requires that all contracts be accompanied by a contract cover sheet that lists the information needed to comply with the procurement policy. The contract cover sheet lists the nature of the procurement, the methods empl...

Identifying Number: 2022-001 Finding: Procurement Corrective Action Taken: DCBF requires that all contracts be accompanied by a contract cover sheet that lists the information needed to comply with the procurement policy. The contract cover sheet lists the nature of the procurement, the methods employed for determining the contractor, whether a sole source determination had been made, and confirmation of the review for suspension or debarment. The contract cover sheet requires review by the Senior Operations and Finance Officer prior to the document and contract being submitted for signature. DCBF will ensure all sole source justifications are documented and such justifications are filed in the appropriate folders accessible by the Operations Team. Person(s) Responsible for Corrective Action Plan: Alison Putnam, Senior Operations and Finance Officer Anticipated Completion Date: September 2023

View Audit 51213

Finding 51398 (2022-001)

Material Weakness 2022

Suburban Mobility Authority for Regional Transportation

MI

Questioned Costs Allowable Costs / Cost Principles Subrecipient Monitoring § 200.403

Finding Type - Material weakness and material noncompliance with laws and regulations Condition ? The Authority disbursed a portion of its CARES Act funds to community partners; however, many of those partners offer only Section 5310 service for seniors and individuals with disabilities. Section 531...

Finding Type - Material weakness and material noncompliance with laws and regulations Condition ? The Authority disbursed a portion of its CARES Act funds to community partners; however, many of those partners offer only Section 5310 service for seniors and individuals with disabilities. Section 5310 program expenses are not allowable under the CARES Act. Identification of How Questioned Costs Were Computed ? Questioned costs represent the total amount of CARES Act funds passed through to community partners. Context - During the fiscal year, SMART passed through $1,146,291 to 35 community partners. Cause and Effect - The CARES Act award was new to SMART in fiscal year 2020. SMART's other federal awards have existed for many years and SMART is very familiar with their requirements and allowable uses. SMART sought to share the new award with its community partners but was not aware that most of them did not have expenditures allowable under the CARES Act until the matter was identified during SMART's most recent triennial review. Recommendation - When new awards are received, we recommend SMART thoroughly analyze the compliance requirements, including the allowable uses. Views of Responsible Officials and Corrective Action Plan ? SMART management is aware of the issue and has been diligently working with our FTA regional office to correct the issue. While certain community partner expenses were not eligible under CARES, they are certainly eligible under CRRSA and ARPA funding grants. We are in the process of finalizing a plan, with the FTA, where all community partner relief funding will be reprogramed under the CRRSA and ARPA grants. This correction plan, once finalized, will result in no reduction of federal relief funding to SMART or any of our community partners. Given extraordinary circumstances and expedited nature of the CARES funding, we do not believe that this issue will be a significant risk for future grant funding, however SMART has modified our grant policy manual to ensure a more thorough review of eligible expenses for subrecipients. Contact person responsible for corrective action: Ryan Byrne, CFO Anticipated Completion Date: 12/31/2022

View Audit 49229 Questioned Costs: $1

Finding 51382 (2022-004)

Material Weakness 2022

Alliance Public Schools

NE

Subrecipient Monitoring Allowable Costs / Cost Principles Internal Control / Segregation of Duties

Finding 2022-004: Compliance with Davis Bacon Act and Lack of Documentation on Expenditures of Federal Awards the District's internal control system was not designed to monitor the requirements of the Davis Bacon Act, specifically the prevailing wage requirements, for federal expenditures of the Ele...

Finding 2022-004: Compliance with Davis Bacon Act and Lack of Documentation on Expenditures of Federal Awards the District's internal control system was not designed to monitor the requirements of the Davis Bacon Act, specifically the prevailing wage requirements, for federal expenditures of the Elementary and Secondary School Emergency Relief Funds (ESSERII). The District will obtain the documentation to support the prevailing wage requirements when subject to the Davis Bacon Act and ensure that all expenditures of federal awards have proper documentation to support the expenditure of federal awards.

View Audit 47798

Finding 51366 (2022-001)

Significant Deficiency 2022

South Orange County Community College District

CA

Subrecipient Monitoring Special Tests & Provisions Student Financial Aid

Department of Education, South Orange County Community College District respectfully submits the following corrective action plan for the year ended June 30, 2022. Audit period: July 1, 2021 ? June 30, 2022 The findings from the schedule of findings and questioned costs are discussed below. The find...

Department of Education, South Orange County Community College District respectfully submits the following corrective action plan for the year ended June 30, 2022. Audit period: July 1, 2021 ? June 30, 2022 The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAMS AUDITS Department of Education 2022 ? 001 Special Tests and Provisions Recommendation: The District should strengthen internal controls to ensure that they are identifying students who withdraw without notification in a timely manner. Additionally, the District should also establish controls for further review of the Return to Title IV (R2T4) calculations to ensure that the data utilized in preparing the calculation is accurate. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: In order to ensure R2T4 calculations are performed within 30 days of the end of the period of enrollment, Saddleback College Financial Aid will review the report that identifies students who withdraw without providing notification to the institution periodically throughout the term. Initially after the freeze date, a second time after the grade posting deadline date for each term, and a third time within 30 days from the day the term ends. Scheduled review dates will also be included on the annual R2T4 Schedule. Further, in order to ensure the data utilized to calculate the R2T4 is accurate, all R2T4 worksheets and supporting documentation will be reviewed by the Senior Financial Aid Specialist or Director, Financial Aid prior to processing the return of funds. In addition, corrected calculations were completed and additional funds were returned, as required.Name(s) of the contact person(s) responsible for corrective action: Anthony Becerra (Saddleback College, Director, Financial Aid) and Christian Alvarado (Saddleback College, Dean, Enrollment Services) Planned completion date for corrective action plan: June 30, 2023 If the Department of Education has questions regarding this plan, please call Richard Kudlik, District Internal Auditor, at (949)582-4647

View Audit 45150

Finding 51323 (2022-001)

Material Weakness 2022

City of Lebanon

IN

Procurement, Suspension & Debarment Subrecipient Monitoring § 200.303

FINDING 2022-001 Contact Person Responsible for Corrective Action: Tonya Thayer Contact Phone Number: 1-765-482-1218 Views of Responsible Official: We concur with the finding the City did not have the correct system in place to prevent errors. Description of Corrective Action Plan: From this day for...

FINDING 2022-001 Contact Person Responsible for Corrective Action: Tonya Thayer Contact Phone Number: 1-765-482-1218 Views of Responsible Official: We concur with the finding the City did not have the correct system in place to prevent errors. Description of Corrective Action Plan: From this day forward any Federal contracts the City signs that are $25,000 and over will need to be verified by Deputy Clerk Treasurer by looking at the SAM (System for Award Management) to make sure the contractor is not suspended or debarred. Anticipated Completion Date: June 28, 2023

View Audit 51086

Finding 51290 (2022-002)

None 2022

Mississippi Alliance of Boys & Girls Clubs, Inc.

MS

Internal Control / Segregation of Duties Subrecipient Monitoring Reporting

Individuals Responsible for Corrective Action Plan: Dominique Dye, Mississippi Alliance Grant Administration LaKenya Evans, Mississippi Alliance Grant Administration Corrective Action: The Alliance will implement more stringent internal controls and administrative oversight with respect to reporting...

Individuals Responsible for Corrective Action Plan: Dominique Dye, Mississippi Alliance Grant Administration LaKenya Evans, Mississippi Alliance Grant Administration Corrective Action: The Alliance will implement more stringent internal controls and administrative oversight with respect to reporting requirements and deadlines to make sure ALL financial reports are submitted timely to the respective awarding agencies. Anticipated Completion Date: October 1, 2023

View Audit 48169

Finding 51262 (2022-001)

Significant Deficiency 2022

Washoe County

NV

Subrecipient Monitoring Reporting Significant Deficiency

Response Does the Agency Agree with finding?: Yes ? No ? Partially ? If No or Partial, Please explain reason(s) why: Additional Comments: Division Responsible for Corrective Action Plan Cathy Name, Title: Cathy Hill, Comptroller Address or Mailstop: 1001 E. Ninth St. City, State, Zip Code: Reno, NV ...

Response Does the Agency Agree with finding?: Yes ? No ? Partially ? If No or Partial, Please explain reason(s) why: Additional Comments: Division Responsible for Corrective Action Plan Cathy Name, Title: Cathy Hill, Comptroller Address or Mailstop: 1001 E. Ninth St. City, State, Zip Code: Reno, NV 89512 Phone Number: (775) 328-2552 Email: chill@washoecounty.gov

View Audit 42081

Finding 51261 (2022-002)

Significant Deficiency 2022

Edadvance

CT

Subrecipient Monitoring

Department of Health and Human Services 2022-002 Maternal, Infant, and Early Childhood Home Visiting Grant Program ? 93.870 Recommendation: We recommend that management strengthen controls over subrecipient monitoring procedures. Explanation of disagreement with audit finding: There is no disagreeme...

Department of Health and Human Services 2022-002 Maternal, Infant, and Early Childhood Home Visiting Grant Program ? 93.870 Recommendation: We recommend that management strengthen controls over subrecipient monitoring procedures. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Revisit federal regulations with the Grants Development Specialist and the Program Director currently administrating federal grants with subrecipients to develop new procedures/tool for Subrecipients monitoring. After completion of new procedure, final document will be presented to Board of Directors for approval. Name(s) of the contact person(s) responsible for corrective action: Mia Toimil, Director of Finance Abby Peklo, Director of Grants & Special Programs Michelle Anderson, Director of Early Childhood and Family Programs Planned completion date for corrective action plan: We expect to have the correction action plan completed by June 30, 2023. If the Agency has questions regarding this plan, please call Mia Toimil at 860-567-0863 EXT 1157.

View Audit 42830

Finding 51260 (2022-001)

Significant Deficiency 2022

Edadvance

CT

Procurement, Suspension & Debarment Subrecipient Monitoring Significant Deficiency

To Whom it May Concern: EdAdvance respectfully submits the following corrective action plan for the year ended June 30, 2022. Audit period: July 1, 2021 ? June 30, 2022 The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with th...

To Whom it May Concern: EdAdvance respectfully submits the following corrective action plan for the year ended June 30, 2022. Audit period: July 1, 2021 ? June 30, 2022 The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAMS AUDITS Department of Health and Human Services 2022-001 Maternal, Infant, and Early Childhood Home Visiting Grant Program ? 93.870 Recommendation: We recommend that management retain documentation of verification of suspension or debarment review performed over subrecipients. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Director of Finance in conjunction with Director of Grants & Special Programs will draft a certification that will act as a verification tool to rule out that potential subrecipients have not been suspended or debarred from doing business with the federal government prior to engaging in any legal contract. The document will be presented to Board of Directors for approval, then it will be shared with all EdAdvance Program Directors to make them aware of this requirement when working with subrecipients. Name(s) of the contact person(s) responsible for corrective action: Mia Toimil, Director of Finance Abby Peklo, Director of Grants & Special Programs Planned completion date for corrective action plan: Expected completed date 06/30/2023.

View Audit 42830

Finding 51255 (2022-001)

Material Weakness 2022

Brown County Schools

IN

Internal Control / Segregation of Duties Special Tests & Provisions Material Weakness § 200.303

FINDING 2022-001 Contact Person Responsible for Corrective Action: Dawn Ray Contact Phone Number: 812-988-6601 Views of Responsible Official: Brown County Schools viewed this Internal Controls requirement as being fulfilled by Performance Services, Inc. (PSI) as part of their responsibilities as...

FINDING 2022-001 Contact Person Responsible for Corrective Action: Dawn Ray Contact Phone Number: 812-988-6601 Views of Responsible Official: Brown County Schools viewed this Internal Controls requirement as being fulfilled by Performance Services, Inc. (PSI) as part of their responsibilities as contractor for their sub-contractor?s certified payroll as it is addressed in PSI?s sub-contractor contract. The sub-contractor sends their certified payroll to PSI who verifies all information including Wage Rate requirements before rendering payment. Brown County Schools did not know that we were to complete this extra step. Description of Corrective Action Plan: Brown County Schools will require notification of certified payroll reviews be sent to us with the monthly work updates after the contractor has reviewed them for accuracy and compliance with prevailing wage requirements. Anticipated Completion Date: Effective immediately at conclusion of the 2020-2022 audit.

View Audit 43527

Finding 51250 (2022-029)

Material Weakness 2022

State of Delaware

DE

Subrecipient Monitoring Reporting § 200.1 § 200.303 § 200.332 § 200.501 § 200.521

Reference Number: 2022-029 Prior Year Finding: 2021-027 Federal Agency: U.S. Department Homeland Security State Department Name: Department of Safety and Homeland Security, Federal Emergency Management Agency (FEMA) State Division Name: Delaware Emergency Management Agency (DEMA) Federal Program: Di...

Reference Number: 2022-029 Prior Year Finding: 2021-027 Federal Agency: U.S. Department Homeland Security State Department Name: Department of Safety and Homeland Security, Federal Emergency Management Agency (FEMA) State Division Name: Delaware Emergency Management Agency (DEMA) Federal Program: Disaster Grants - Public Assistance (Presidentially Declared Disasters), COVID-19 ? Disaster Grants ? Public Assistance (Presidentially Declared Disasters) Assistance Listing Number: 97.036 Award Number and Year: 4526-DR-DE (2022), 4566-DR-DE (2022), 4627-DR-DE (2022) Compliance Requirement: Subrecipient Monitoring Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: DEMA should review and enhance internal controls and procedures to ensure that all required information is included in all subawards, that subrecipients are properly monitored, and that evaluation of independent audits is performed. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: A contractor has been assigned to develop and implement internal controls to ensure all required information is included in all subawards, that subrecipients are properly monitored, and that evaluation of independent audits is performed. Subaward letters were updated in September 2022 and a monitoring protocol implemented to begin monitoring all subrecipients to date to include an evaluation of independent audits that is documented as part of the monitoring visit. Name(s) of the contact person(s) responsible for corrective action: Tramaine Childs Disaster Recovery Specialist Innovative Emergency Management Inc. 318.278.2813 (Mobile) Tramaine.Childs@iem.com Planned completion date for corrective action plan: September 26, 2022

View Audit 43524

Finding 51249 (2022-028)

Material Weakness 2022

State of Delaware

DE

Matching / Level of Effort / Earmarking Subrecipient Monitoring Material Weakness § 200.303

Reference Number: 2022-028 Prior Year Finding: No Federal Agency: U.S. Department Homeland Security State Agency: Department of Safety and Homeland Security, Federal Emergency Management Agency (FEMA) State Division: Delaware Emergency Management Agency (DEMA) Federal Program: Disaster Grants - Publ...

Reference Number: 2022-028 Prior Year Finding: No Federal Agency: U.S. Department Homeland Security State Agency: Department of Safety and Homeland Security, Federal Emergency Management Agency (FEMA) State Division: Delaware Emergency Management Agency (DEMA) Federal Program: Disaster Grants - Public Assistance (Presidentially Declared Disasters), COVID-19 ? Disaster Grants ? Public Assistance (Presidentially Declared Disasters) Assistance Listing Number: 97.036 Award Number and Year: 4526-DR-DE (2022), 4566-DR-DE (2022), 4627-DR-DE (2022) Compliance Requirement: Reporting ? Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: We recommend that DEMA enhance internal controls and procedures to ensure that FFATA reporting requirements are met and supporting documentation for submission is maintained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: DEMA finance section has created a group account for FFATA reporting using the group email DEMAFiscal@delaware.gov to enable anyone in that section to access, edit, and submit reports as needed. This will ensure that everyone in the finance section has access to information regardless of turnover. This will also share the workload and assist with timely reporting. Name(s) of the contact person(s) responsible for corrective action: Frances Cordell Manager, Support Services (302) 659-2244 (office) (302) 222-6565 (mobile) Planned completion date for corrective action plan: March 20, 2023

View Audit 43524

Finding 51242 (2022-025)

Material Weakness 2022

State of Delaware

DE

Subrecipient Monitoring Material Weakness Reporting § 200.303

Reference Number: 2022-025 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Block Grants for Prevention and Treatment of Substance ...

Reference Number: 2022-025 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Block Grants for Prevention and Treatment of Substance Abuse, COVID-19 - Block Grants for Prevention and Treatment of Substance Abuse Assistance Listing Number: 93.959 Award Number and Year: B08TI083060 (10/1/2019 ? 9/30/2021), B08TI083488 (10/1/2020 ? 9/30/2022) Compliance Requirement: Reporting ? Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: We recommend that the Division develop internal controls and procedures to ensure that FFATA reporting requirements are met. We further recommend the Division develop controls and procedures to ensure that all required subawards are reported accurately and timely to FSRS. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division will reevaluate its current process, implement proper controls for FFATA reporting standards, and ensure subawards are reviewed timely. In addition, staff will be assigned to verify information prior to being keyed into FSRS. Name(s) of the contact person(s) responsible for corrective action: Mequoria Bowden, Chief of Administration, Office of the Secretary Planned completion date for corrective action plan: October 31, 2023

View Audit 43524

Finding 51241 (2022-024)

Material Weakness 2022

State of Delaware

DE

Subrecipient Monitoring Reporting § 200.303 § 200.332 § 200.425 § 200.501 § 200.521

Reference Number: 2022-024 Prior Year Finding: 2021-024 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Substance Abuse and Mental Health Federal Program: Block Grants for Prevention and Tre...

Reference Number: 2022-024 Prior Year Finding: 2021-024 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Substance Abuse and Mental Health Federal Program: Block Grants for Prevention and Treatment of Substance Abuse, COVID-10 - Block Grants for Prevention and Treatment of Substance Abuse Assistance Listing Number: 93.959 Award Number and Year: B08TI083060 (10/1/2019 ? 9/30/2021), B08TI083488 (10/1/2020 ? 9/30/2022) Compliance Requirement: Subrecipient Monitoring Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: The Division should review and enhance internal controls and procedures to ensure that all required information is included in all subawards and provided to the subrecipients, that proper subrecipient monitoring is conducted, and that evaluation of independent audits is performed. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division has been working to implement corrective action. DSAMH continues to update and enhance policies and procedures to ensure that proper subrecipient monitoring is conducted in accordance with Federal regulations. Name(s) of the contact person(s) responsible for corrective action: Mequoria Bowden, Chief of Administration Office of the Secretary Administration Planned completion date for corrective action plan: October 31, 2023

View Audit 43524

Finding 51240 (2022-023)

Significant Deficiency 2022

State of Delaware

DE

Subrecipient Monitoring § 200.303 § 200.332 § 200.425 § 200.521

Reference Number: 2022-023 Prior Year Finding: 2021-018 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Substance Abuse and Mental Health Federal Program: Opioid STR Assistance Listing Numbe...

Reference Number: 2022-023 Prior Year Finding: 2021-018 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Substance Abuse and Mental Health Federal Program: Opioid STR Assistance Listing Number: 93.788 Award Number and Year: H79TI083305 (9/30/2020 ? 9/29/2022) Compliance Requirement: Subrecipient Monitoring Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should review and enhance internal controls and procedures to ensure that proper subrecipient monitoring is conducted in accordance with Federal regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division has been working to implement corrective action. DSAMH continues to update and enhance policies and procedures to ensure that proper subrecipient monitoring is conducted in accordance with Federal regulations. Name(s) of the contact person(s) responsible for corrective action: Mequoria Bowden, Chief of Administration, Office of the Secretary Administration Planned completion date for corrective action plan: October 31, 2023

View Audit 43524

Finding 51239 (2022-022)

Material Weakness 2022

State of Delaware

DE

Subrecipient Monitoring Material Weakness Reporting § 200.303

Reference Number: 2022-022 Prior Year Finding: 2021-020 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Opioid STR Assistance Listing Number: 93.788 Awar...

Reference Number: 2022-022 Prior Year Finding: 2021-020 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Opioid STR Assistance Listing Number: 93.788 Award Number and Year: H79TI083305 (9/30/2020 ? 9/29/2022) Compliance Requirement: Reporting ? Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: We recommend that the Division develop internal controls and procedures to ensure that FFATA reporting requirements are met. We further recommend the Division develop controls and procedures to ensure that all required subawards are reported accurately and timely to FSRS. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division will reevaluate its current process, implement proper controls for FFATA reporting standards, and ensure subawards are reviewed timely. In addition, staff will be assigned to verify information prior to being keyed into FSRS. Name(s) of the contact person(s) responsible for corrective action: Mequoria Bowden, Chief of Administration, Office of the Secretary Administration Planned completion date for corrective action plan: October 31, 2023

View Audit 43524

Finding 51229 (2022-021)

Material Weakness 2022

State of Delaware

DE

Internal Control / Segregation of Duties Special Tests & Provisions Subrecipient Monitoring § 200.303

Reference Number: 2022-021 Prior Year Finding: 2021-015 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Children?s Health Insurance Program M...

Reference Number: 2022-021 Prior Year Finding: 2021-015 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Children?s Health Insurance Program Medicaid Cluster Assistance Listing Number: 93.767, 93.775, 93.777, 93.778 Award Number and Year: 2105DE5021 (10/1/2020 ? 9/30/2022), 2205DE5021 (10/1/2021 ? 9/30/2023) 2105DE5MAP (10/1/2020 ? 9/30/2021), 2205DE5MAP (10/1/2021 ? 9/30/2022) Compliance Requirement: Special Tests ? Provider Eligibility Type of Finding: Material Weakness in Internal Control over Compliance, Material Noncompliance Recommendation: The Division should reevaluate its current process and perform additional training for determining and monitoring provider eligibility. More thorough reviews and supervision should be placed around the provider eligibility processes. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division is reevaluating the current process for validating non-Par provider eligibility. This includes developing additional training for determining and monitoring provider eligibility and researching best practices in this area. The Division will also complete more thorough reviews and exercise increased supervisory oversight around the provider eligibility processes. Name(s) of the contact person(s) responsible for corrective action: Kathleen Dougherty Planned completion date for corrective action plan: September 30, 2023

View Audit 43524

Finding 51226 (2022-018)

Material Weakness 2022

State of Delaware

DE

Questioned Costs Allowable Costs / Cost Principles Subrecipient Monitoring § 200.303 § 200.308 § 200.309 § 200.403

Reference Number: 2022-018 Prior Year Finding: 2021-014 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Children?s Health Insurance Program (...

Reference Number: 2022-018 Prior Year Finding: 2021-014 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Children?s Health Insurance Program (CHIP) Assistance Listing Number: 93.767 Award Number and Year: 2205DE5021 (10/1/2021 ? 9/30/2023) Compliance Requirement: Period of Performance Type of Finding: Material Weakness in Internal Control over Compliance, Material Noncompliance Recommendation: The Division should review and enhance internal controls and procedures to ensure that it charges expenditures to the program that are incurred within an award?s allowable period of performance. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: DMMA will review reported expenditures based on the date of the federal draw to ensure that the expenditures occured within the period reported. Name(s) of the contact person(s) responsible for corrective action: Unkyong Goldie Planned completion date for corrective action plan: September 30, 2023

View Audit 43524 Questioned Costs: $1

Finding 51224 (2022-017)

Material Weakness 2022

State of Delaware

DE

Subrecipient Monitoring Material Weakness Reporting § 200.303

Reference Number: 2022-017 Prior Year Finding: 2021-013 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of State Service Centers Federal Program: COVID-19 ? Low-Income Home Energy Assistance Assistance Listi...

Reference Number: 2022-017 Prior Year Finding: 2021-013 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of State Service Centers Federal Program: COVID-19 ? Low-Income Home Energy Assistance Assistance Listing Number: 93.568 Award Number and Year: 2001DELIEA (10/1/2019 ? 9/30/2021), 2101DELIEA (10/102020 ? 9/30/2022), 2010DEE5C6 (3/11/2021 ? 9/30/2022), 2201DELIEA (10/1/2021 ? 9/30/2023) Compliance Requirement: Reporting ? Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: We recommend that the Division develop internal controls and procedures to ensure that FFATA reporting requirements are met. We further recommend the Division develop controls and procedures to ensure that all required subawards are reported accurately and timely to FSRS. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division has developed internal controls and procedures to ensure that FFATA reporting requirments are met and subawards are reported accurately and timely to FSRS. Specifically, the Division and Fiscal staff will work together to collect required information from the contractors and enter the FFATA information into FSRS portal. All contracts will have additional pages (through appendices) to collect information for FFATA reporting. Name(s) of the contact person(s) responsible for corrective action: Christopher Antonio Haly Laasme-McQuilkin Planned completion date for corrective action plan: June 30, 2023

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Finding 51218 (2022-013)

Significant Deficiency 2022

State of Delaware

DE

Subrecipient Monitoring Reporting Significant Deficiency § 200.303

Reference Number: 2022-013 Prior Year Finding: 2021-011 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Public Health Federal Program: COVID-19 ? Epidemiology and Laboratory Capacity for Inf...

Reference Number: 2022-013 Prior Year Finding: 2021-011 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Public Health Federal Program: COVID-19 ? Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Assistance Listing Number: 93.323 Award Number and Year: NU50CK000497 (8/1/2019 ? 7/31/2024) Compliance Requirement: Reporting Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should review and enhance internal controls and procedures to ensure that quarterly Progress Monitoring reports are filed timely and that it maintains documentation supporting timely submission. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division of Public Health (DPH) filed its quarterly Progress Monitoring reports timely but failed to maintain supporting documentation. DPH is saving all reports as PDF documents as they are submitted to the Federal Program via REDCap to timestamp the submission dates. The Federal Program announced that they were switching from the REDCap system to the CAMP system for compliance reporting. We verified that the CAMP system will not have the function to pull timestamped records, therefore we will continue the process of saving PDF documents from the new system, to show timely submission. DPH will continue evaluate the current process for submission of the compliance reporting to check for gaps in the process. Name(s) of the contact person(s) responsible for corrective action: Wes Holleger, Laboratory Deputy Director, Division of Public Health Planned completion date for corrective action plan: June 30, 2023

View Audit 43524

Finding 51204 (2022-011)

Significant Deficiency 2022

State of Delaware

DE

Procurement, Suspension & Debarment Subrecipient Monitoring § 200.214 § 200.303 § 200.317

Reference Number: 2022-011 Prior Year Finding: No Federal Agency: U.S. Department of the Treasury State Department Name: Department of Health and Social Services State Division Name: Division of Social Services Federal Program: COVID-19 ? Coronavirus State and Local Fiscal Recovery Funds Assistance ...

Reference Number: 2022-011 Prior Year Finding: No Federal Agency: U.S. Department of the Treasury State Department Name: Department of Health and Social Services State Division Name: Division of Social Services Federal Program: COVID-19 ? Coronavirus State and Local Fiscal Recovery Funds Assistance Listing Number: 21.027 Award Number and Year: SLFRP0139 (3/3/2021 ? 12/31/2024) SLFRP2629 (3/3/2021 ? 12/31/2024) Compliance Requirement: Procurement, Suspension & Debarment Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should review and enhance controls and procedures to ensure that it follows the State?s procurement policy and Federal suspension and debarment regulations for all goods and services charged to the program. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: We agree with the auditor?s recommendation. Ongoing meeting, training, and monitoring have helped and will continue to help DSS staff to achieve compliance. The following actions have been taken to improve the Procurement process. ? Program unit staff will receive Procurement Bootcamp training on contract rules. ? Program unit & Fiscal unit staff will monitor and track all contracts, MOU/MOA?s and agreement so they are in compliance with State Procurement policy. ? Fiscal unit will ensure they have an approval to pay for any invoices. ? Conduct monthly meetings with OSEC CMP Managers and DSS Fiscal unit. Name(s) of the contact person(s) responsible for corrective action: Thomas Hall, DSS Director Victor Ting, DSS Chief of Administration Janneen Boyce, DSS Policy, Social Service Chief Administrator Joanne Sunga, DSS Fiscal, Social Service Chief Administrator Planned completion date for corrective action plan: ? Procurement Bootcamp training was completed March 22, 2023. ? Procurement monitoring, ongoing. ? Fiscal approval workflow, ongoing. ? Monthly Procurement meeting, ongoing.

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Corrective Action Plans

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