Corrective Action Plans

Finding 424930 (2022-207)

Significant Deficiency 2022

State of Idaho

ID

Subrecipient Monitoring Reporting Internal Control / Segregation of Duties § 200.502 § 200.510

Finding Number 2022-207: The amount reported as passed through to subrecipients on the Schedule of Expenditures of Federal Awards (SEFA) closing package was overstated by $331,500.Federal Programs:15.605 - Sport Fish Restoration15.611 - Wildlife Restoration and Basic Hunter EducationRelated to Prior...

Finding Number 2022-207: The amount reported as passed through to subrecipients on the Schedule of Expenditures of Federal Awards (SEFA) closing package was overstated by $331,500.Federal Programs:15.605 - Sport Fish Restoration15.611 - Wildlife Restoration and Basic Hunter EducationRelated to Prior Finding: N/AAgency?s view: The Department agrees with this finding.Corrective Action: The Department will provide additional training and update its procedural documentation to ensure that expenses are thoroughly vetted before they are reported as subrecipient expenditures on the SEFA. Each expenditure identified as a subrecipient expense will be tied back to a specific subaward, further limiting the possibility of non-subaward expenses being reported in the subrecipient portion of the SEFA.Anticipated Corrective Action Date: This corrective action plan will be implemented by the end of August 2023.Responsible for Corrective Action: Michael Pearson, Chief, Bureau of Administrationmichael.pearson@idfg.idaho.gov(208) 287-2800Jon Oswald, Financial Managerjonathan.oswald@idfg.idaho.gov(208) 287-2820

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Finding 424928 (2022-209)

Material Weakness 2022

State of Idaho

ID

Equipment & Real Property Management Internal Control / Segregation of Duties Special Tests & Provisions § 200.303

Finding Number 2022-209: An annual physical inventory was not completed for all storage facilities used by sub-distributing agencies for the Emergency Food Assistance Program as required by federal guidance.Federal Program: 10.568 - Emergency Food Assistance ProgramRelated to Prior Finding: N/AAgenc...

Finding Number 2022-209: An annual physical inventory was not completed for all storage facilities used by sub-distributing agencies for the Emergency Food Assistance Program as required by federal guidance.Federal Program: 10.568 - Emergency Food Assistance ProgramRelated to Prior Finding: N/AAgency?s view: The Department agrees with this finding.Corrective Action: The Department questioned and relied upon an opinion from the National Office of USDA Food and Nutrition Service (FNS), which administers TEFAP, affirming the Department?s interpretation of the regulations for this program. Dixon, R. (2023) Email to Cho Heide, March 23. In that opinion the Department asserted and FNS agreed that the requirements for an annual physical review of food inventories only applies to storage facilities used by the state distributing agency or sub-distributing agencies (as defined in 7 CFR 250.2). The Department has always considered the organizations with which we have subgrant agreements for TEFAP to be eligible recipient agencies (as defined in 7 CFR 251.3), not sub-distributing agencies. The Department provided this information to LSO auditors but on review with them as relates to the compliance supplement for this program, it became clear that the guidance from FNS was not authoritative and therefore, did not supersede the compliance supplement. With this knowledge, the Department will work with FNS to clarify requirements within the compliance supplement, revising our control process in this program accordingly.Anticipated Corrective Action Date: July 2023Responsible for Corrective Action: Kelly Combs, Bureau Chief, Compliancekelly.combs@dhw.idaho.gov 208-334-5814

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Finding 424926 (2022-212)

Material Weakness 2022

State of Idaho

ID

Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties Special Tests & Provisions § 200.303

Finding Number 2022-212: The Department did not maintain consistent operation of controls and compliance with Electronic Benefit Transfer (EBT) Card Security procedures for the Supplemental Nutrition Assistance Program (SNAP).Federal Programs:10.551 - Supplemental Nutrition Assistance Program (SNAP)...

Finding Number 2022-212: The Department did not maintain consistent operation of controls and compliance with Electronic Benefit Transfer (EBT) Card Security procedures for the Supplemental Nutrition Assistance Program (SNAP).Federal Programs:10.551 - Supplemental Nutrition Assistance Program (SNAP)10.561 - State Administrative Matching Grants for the Supplemental Nutrition Assistance ProgramRelated to Prior Finding: 2021-210Agency?s view: The Department agrees with this finding.Corrective Action: Immediately upon receiving the audit finding in March 2022, staffreviewed and revised procedures and fully implemented a corrective action plan by June 30, 2022. The entire EBT team was trained on the bulk card ordering and issuing process and modified security procedures to mitigate the risk of non-compliance in the future. The bulk card managers in the field offices review and reconcile card issuances monthly. Also, the EBT Supervisor documents the review of the previous quarter?s electronic card audits for accuracy and completeness.Anticipated Corrective Action Date: See corrective action above.Responsible for Corrective Action: Kelly Combs, Bureau Chief, Compliancekelly.combs@dhw.idaho.gov 208-334-5814

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Finding 424447 (2022-002)

Significant Deficiency 2022

Iowa Health System and Subsidiaries Dba Unitypoint Health

IA

Questioned Costs

Personnel Responsible for Corrective Action: Regional Grant ManagersAnticipated Completion Date:12/31/23Corrective Action Plan:UPH will implement consistent reconciliation practices for comparing grant disbursements to grant expenses recorded on the SEFA.

View Audit 312362 Questioned Costs: $1

Finding 424444 (2022-001)

Significant Deficiency 2022

Iowa Health System and Subsidiaries Dba Unitypoint Health

IA

Personnel Responsible for Corrective Action: Director of Centralized Accounting Operations, Director Internal AuditAnticipated Completion Date:12/31/23Corrective Action Plan:UPH will review and update finance policies applicable to Grants and GrantAccounting to include expectations for tracking, tim...

Personnel Responsible for Corrective Action: Director of Centralized Accounting Operations, Director Internal AuditAnticipated Completion Date:12/31/23Corrective Action Plan:UPH will review and update finance policies applicable to Grants and GrantAccounting to include expectations for tracking, timely reporting, documentationof review and approval of grant reporting

View Audit 312362

Finding 423470 (2022-001)

Significant Deficiency 2022

State System of Higher Education, Commonwealth of Pennsylvania

PA

Allowable Costs / Cost Principles Reporting Significant Deficiency § 200.303

LockHaven: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to fi...

LockHaven: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: The University will review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately. The University will put necessary controls in place to ensure reports are posted within ten days of the end of the quarter. Documentation of report review and approval will be in writing and saved to ensure documentation is available to support review and approval of report submissions.Name(s) of the contact person(s) responsible for corrective action: Michael Hall, Director of Financial Aid.Planned completion date for corrective action plan: April 30, 2023Clarion: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: This finding resulted from a combination of staff turnover and the complexity of integration. All grant-related reporting requirements will be reviewed to ensure that they are properly documented and scheduled for completion and review when required by the granting authority.Name(s) of the contact person(s) responsible for corrective action: Sean Bliley, Controller, 814-732-1304Planned completion date for corrective action plan: June 30, 2023Bloomsburg: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: We have reviewed the reporting requirements published by the federal government to ensure compliance with all procedures. In addition, we have established review procedures so that each document is reviewed prior to publishing on our website.Name(s) of the contact person(s) responsible for corrective action: : Amanda Kishbaugh at (570) 389-4497.Planned completion date for corrective action plan: April 30, 2023Edinboro: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: All grant-related reporting requirements will be reviewed to ensure that they are properly documented and scheduled for completion and review when required by the granting authority.Name(s) of the contact person(s) responsible for corrective action: Sean Bliley, Controller, 814-732-1304. Planned completion date for corrective action plan: 06/30/2023California: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately. Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: This finding resulted from a combination of staff turnover and the complexity of integration. All grant-related reporting requirements will be reviewed to ensure that they are properly documented and scheduled for completion and review when required by the granting authority.Name(s) of the contact person(s) responsible for corrective action: Sean Bliley, Controller, 814-732-1304Planned completion date for corrective action plan: June 30, 2023 Mansfield: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: The University will review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately. Documentation of report review and approval will be in writing and saved to ensure documentation is available to support review and approval of report submissions.Name(s) of the contact person(s) responsible for corrective action: Colleen Jackson, Assistant Controller, Pam Kathcart, Director of Financial AidPlanned completion date for corrective action plan: April 30, 2023 Millersville: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: The finding related to the institutional report not being displayed on the website refers to reporting of December 31st, 2021 (due to be posted on website by January 10th, 2022). The university was alerted to the issue of approval requirements during the last single audit process, which was after the December 31st report was posted. All reports posted to the website after the finding in last year?s audit were completed with Finance and Administration Vice President or Associate Vice President approvals prior to posting.Name(s) of the contact person(s) responsible for corrective action: Tammy Aument-Martin, Director of Accounting & Budget at 717-871-4091 and Emi Alvarez, Director of Financial Aid at 717-871-5100.Planned completion date for corrective action plan: 06/30/2022 (all HEERF funds were drawn down and recorded) Cheyney: Recommendation: The University should review its policies and procedures around grant reporting to ensure all reporting requirements are met timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: Additional policies and procedures were implemented to mitigate errors in the future.Planned completion date for corrective action plan: 9/30/2023Name(s) of the contact person(s) responsible for corrective action: Victoria Atkins at (610) 399-2097.

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Finding 423469 (2022-007)

Significant Deficiency 2022

State System of Higher Education, Commonwealth of Pennsylvania

PA

Student Financial Aid Significant Deficiency Matching / Level of Effort / Earmarking

Lockhaven: Recommendation: The University should ensure all necessary employees receive proper training, support, and time to follow the university policies and federal requirements related to monthly reconciliations and maintenance of documentation.Explanation of disagreement with audit finding: Th...

Lockhaven: Recommendation: The University should ensure all necessary employees receive proper training, support, and time to follow the university policies and federal requirements related to monthly reconciliations and maintenance of documentation.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: All employees will receive proper training, support, and time to follow the university policies and federal requirements related to monthly reconciliations and maintenance of documentation. The reconciliation will be reviewed and signed off of monthly ensuring proper documentation is on file to validate the review process.Name(s) of the contact person(s) responsible for corrective action: Michael Hall, Director of Financial Aid.Planned completion date for corrective action plan: June 30, 2023

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Finding 423468 (2022-005)

Significant Deficiency 2022

State System of Higher Education, Commonwealth of Pennsylvania

PA

Student Financial Aid Eligibility Significant Deficiency

California: Recommendation: We recommend the Institute review its policies and procedures around sending entrance and exit counseling information to students to ensure students are receiving proper counseling and ensure entrance counseling is documented before loans disbursements are made.Explanatio...

California: Recommendation: We recommend the Institute review its policies and procedures around sending entrance and exit counseling information to students to ensure students are receiving proper counseling and ensure entrance counseling is documented before loans disbursements are made.Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: A process in banner is run to catch any new students that need RRAAREQ updates with exit counseling. This will get students who have withdrawn, less than 1/2-time attendance, not enrolled, graduated or schedule to graduate. Once the requirement is on the account, then another process is run to get all of the students with the EXIT code still outstanding and send an e-mail to campus and personal e-mail. Students will receive emails every 30 days to complete the requirement until it is satisfied.Name(s) of the contact person(s) responsible for corrective action: Financial Aid Office, California, Clarion and Edinboro- Kelly Vitelli, Sue Bloom or Traci NecciaiPlanned completion date for corrective action plan: Plan is currently being employed.

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Finding 423465 (2022-002)

Significant Deficiency 2022

State System of Higher Education, Commonwealth of Pennsylvania

PA

Student Financial Aid Reporting Significant Deficiency

Kutztown: Recommendation: The University should review its reporting procedures to ensure that students? statuses are timely reported to NSLDS as required by Federal regulations.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response t...

Kutztown: Recommendation: The University should review its reporting procedures to ensure that students? statuses are timely reported to NSLDS as required by Federal regulations.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: We are re-evaluating our reporting procedures and will work with the Registrar?s Office to further redefine our process(es). Currently, the Registrar?s Office submits monthly transmissions to NSC (National Student Clearinghouse), who in turn updates our information to NSLDS. Moving forward, a financial aid resource will work in conjunction with the Registrar?s Office to ensure errors are addressed timely to certify the accuracy of our reporting.Name(s) of the contact person(s) responsible for corrective action: Bernard McCree, Director of Financial Aid Services, at 610-683-4032 or mccree@kutztown.edu.Planned completion date for corrective action plan: June 30, 2023 Cheyney: Recommendation: The University should review its reporting procedures to ensure that students? statuses are timely reported to NSLDS as required by Federal regulations.Explanation of disagreement with audit finding: Per federal regulations 34 CFR 685.309(b), 682.610(c), and 674.33(j), Management concurs with the finding. There is no disagreement with the audit finding.Action taken in response to finding: Cheyney University of Pennsylvania utilizes the National Student Clearinghouse as a third-party service provider for enrollment reporting and provides all enrollment data to NSC, believing that enrollment would be reported to NSLDS in compliance with federal regulations; unfortunately, NSC only includes enrollment data for students on the enrollment roster they receive from the National Student Loan Data System (NSLDS). Cheyney University is a Heightened Cash Monitoring 2 (HCM2) institution, and students' Title IV aid/ disbursements are reported differently than advance pay institutions. Students did not appear on the rosters, so NSC did not provide the enrollment data to NSLDS. While investigating the issues with enrollment reporting for our HCM2 students, Cheyney University learned that NSLDS did not receive students' enrollment from NSC. As of spring 2023, Cheyney University has implemented procedures to report enrollment for all Title IV recipients to NSLDS.Name(s) of the contact person(s) responsible for corrective action: Rhonda Thompson, RegistrarPlanned completion date for corrective action plan: January 15, 2023

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Finding 423464 (2022-006)

Significant Deficiency 2022

State System of Higher Education, Commonwealth of Pennsylvania

PA

Student Financial Aid Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Kutztown: Recommendation: The University should review its policies and procedures around COD reporting to ensure students? information is reported timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to findin...

Kutztown: Recommendation: The University should review its policies and procedures around COD reporting to ensure students? information is reported timely and accurately.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: We are reviewing our policies and procedures for COD reporting. A financial aid resource will refine their calendar to ensure that we are in compliance with the 15-day rule for PELL reporting is met consistently.Name(s) of the contact person(s) responsible for corrective action: Bernard McCree, Director of Financial Aid Services, at 610-683-4032 or mccree@kutztown.edu.Planned completion date for corrective action plan: June 30, 2023

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Finding 423461 (2022-003)

Significant Deficiency 2022

State System of Higher Education, Commonwealth of Pennsylvania

PA

Student Financial Aid Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Kutztown: Recommendation:a. The University should evaluate their procedures and review policies surrounding reporting status changes to NSLDS to ensure the enrollment effective date reported to NSLDS is aligning with the University?s last date of attendance.d. The Universities should evaluate their ...

Kutztown: Recommendation:a. The University should evaluate their procedures and review policies surrounding reporting status changes to NSLDS to ensure the enrollment effective date reported to NSLDS is aligning with the University?s last date of attendance.d. The Universities should evaluate their procedures and review policies surrounding reporting program enrollment statuses to NSLDS.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: We are re-evaluating policies and procedures to ensure compliance in reporting. We will be working with the Registrar?s Office to rectify any errors in a timely fashion, as well as to detail and update our processes moving forward.Name(s) of the contact person(s) responsible for corrective action: Bernard McCree, Director of Financial Aid Services, at 610-683-4032 or mccree@kutztown.edu.Planned completion date for corrective action plan: June 30, 2023Cheyney: Recommendation: The University should evaluate their procedures and review policies surrounding reporting status changes to NSLDS to ensure the enrollment effective date reported to NSLDS is aligning with the University?s last date of attendance.Explanation of disagreement with audit finding: Per federal regulations 34 CFR685.309(b), 682.610(c), and 674.33(j), Management concurs with the finding. There is no disagreement with the audit finding.Action taken in response to finding: Cheyney University of Pennsylvania utilizes the National Student Clearinghouse as a third-party service provider for enrollment reporting and provides all enrollment data to the National Student Clearinghouse. The National Student Clearinghouse only includes enrollment data for students on the enrollment roster they receive from the National Student Loan Data System (NSLDS). Students did not appear on the rosters, so The National Student Clearinghouse did not provide the enrollment data to NSLDS. Cheyney University learned that NSLDS did not receive students' enrollment status changes from NSC. As of spring 2023, Cheyney University has implemented procedures to report enrollment status changes and last date of attendance for all Title IV recipients to NSLDS.Name(s) of the contact person(s) responsible for corrective action: Rhonda Thompson, RegistrarPlanned completion date for corrective action plan: April 30, 2023 California: Recommendation: The University should evaluate their procedures and review policies surrounding reporting enrollment statuses to NSLDS.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: This finding was a direct result of the complexity of the integration. The finding is resolved when the timely submission of the graduation file to NSC and subsequent updating to NSLDS. The Office of the Registrar has a semester calendar that outlines important tasks and associated dates and what team is responsible to complete them. Once the team submits the degree file to NSC, the acceptance notice will be retained.Name(s) of the contact person(s) responsible for corrective action: Office of the Registrar Planned completion date for corrective action plan: Plan is currently being employed. Slippery Rock: Recommendation: The University should review its reporting procedures to ensure that students? statuses are timely reported to NSLDS as required by Federal regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: Before the office of Academic Records closes out a medical withdrawal, NSLDS/NSC files will be checked/notified of the proper LDA.Name(s) of the contact person(s) responsible for corrective action: Rebecca Farren, supervisor; Bobbi Jo Eakman, Clerical Assistant IIPlanned completion date for corrective action plan: immediate

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Finding 423459 (2022-004)

Significant Deficiency 2022

State System of Higher Education, Commonwealth of Pennsylvania

PA

Student Financial Aid Significant Deficiency Internal Control / Segregation of Duties

California: Recommendation: We recommend the University review the R2T4 requirements and implement procedures to ensure the R2T4 calculations are using the correct amount of term days and are accurately completed.Explanation of disagreement with audit finding: There is no disagreement with the audit...

California: Recommendation: We recommend the University review the R2T4 requirements and implement procedures to ensure the R2T4 calculations are using the correct amount of term days and are accurately completed.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: The missing component in this finding was an isolated occurrence of a configuration that is directly related to the integration and is unlikely to occur again. The Office of the Registrar maintains a semester calendar of tasks to be completed with associated dates. The process in place is that the break days for any term are configured by the staff in the Office of the Registrar, management reviews that configuration and then financial aid staff review to confirm.Name(s) of the contact person(s) responsible for corrective action: Management reviews configuration of staff data entry of the break days.Planned completion date for corrective action plan: Plan is currently being employed.

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Finding 422846 (2022-082)

Significant Deficiency 2022

State of Alaska

AK

Questioned Costs Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking § 200.303 § 200.34

Finding: 2022-082 - During the testing of the University of Alaska Fairbanks (UAF) Minority Serving Institution (MSI) expenditures there was an observed instance, among the forty that were tested, of an interdepartmental transaction being claimed as a reimbursable expenditure. Students from the MacC...

Finding: 2022-082 - During the testing of the University of Alaska Fairbanks (UAF) Minority Serving Institution (MSI) expenditures there was an observed instance, among the forty that were tested, of an interdepartmental transaction being claimed as a reimbursable expenditure. Students from the MacClean House dorm, which is operated by the UAF Residence Life unit, were required to quarantine in the MacLean House dorm, which is operated by the College of Rural and Community Development (CRCD) unit. This resulted in the UAF Residence Life unit paying the CRCD unit for the students' housing costs. This transaction was included as areimbursable expenditure, despite having a net $0 impact on the income statement.Questioned Costs: $2,100.97 - ALN 84.425F - Grant Award P425L200248Assistance Listing Number: 84.425FAssistance Listing Title: HEERF MSI PortionViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): There is no disagreement with the audit finding.Corrective Action (corrective action planned): The University of Alaska Fairbanks has removed the interdepartmental transactions from the award. Management will ensure interdepartmental transaction is not included in the expenditures in the future.Completion Date (list anticipated completion date): CompletedAgency Contact (name of person responsible for corrective action): Amanda Wall, Associate Vice Chancellor for Financial Services, 907-474-7552

View Audit 312347 Questioned Costs: $1

Finding 422845 (2022-026)

Material Weakness 2022

State of Alaska

AK

Subrecipient Monitoring Material Weakness Reporting § 200.303

Finding: 2022-026 - FY 22 Federal Funding Accountability and Transparency Act subaward reporting for Elementary and Secondary School Emergency Relief Fund (ESSER) and American Rescue Plan ? Elementary and Secondary School Emergency Relief Fund (ARP ESSER) did not occur for 72 subawards.Questioned Co...

Finding: 2022-026 - FY 22 Federal Funding Accountability and Transparency Act subaward reporting for Elementary and Secondary School Emergency Relief Fund (ESSER) and American Rescue Plan ? Elementary and Secondary School Emergency Relief Fund (ARP ESSER) did not occur for 72 subawards.Questioned Costs: NoneAssistance Listing Number: 84.425D; 84.425UAssistance Listing Title: ESSER ? COVID-19; ARP ESSER ? COVID-19Views of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): The department partially agrees with Finding 2022-026. The department agrees with the count of 72 separate awards not being reported, however the department disagrees with the specific dollar amount listed as ESSER II subawards were not reported. The amount listed is missing $5,483. This amount was awarded to a school district that also received ESSER II SEA Reserve funding under the same grant award and the FFATA reporting system has no mechanism to differentiate between mandatory funding and SEA Reserve funding. Per 2 CFR ? 170.220(b) and FFATA guidance documents, if an award increases to greater than the $30,000 reporting threshold, the full amount of the award must be reported, not just the portion that exceeded the threshold.Corrective Action (corrective action planned): Both the procedures and the financial report used to populate the FFATA reporting have been updated. Department staff have been working with the FFATA help desk for approximately two years, through multiple help desk tickets, and have not been able to make the corrections despite repeated, ongoing follow-up, and intervention by the U.S. Department of Education. The department has not submitted FFATA reporting since April 2022 as most activity for the noted assistance listings is only relevant to reports the department could not access. The FFATA help desk did successfully make those reports accessible again as of February 21, 2023, and the department has since completed the ESSER I (ALN 84.425D) FFATA reporting corrections as of March 3, 2023. The department will make the necessary ESSER II (ALN 84.425D) and ESSER III (ALN 84.425U) corrections and resume normal FFATA reporting as soon as reasonably possible.Completion Date (list anticipated completion date): October 1, 2023Agency Contact (name of person responsible for corrective action): Stephanie Allison, Division Operations Manager, Division of Administrative Services

View Audit 312347

Finding 422844 (2022-027)

Significant Deficiency 2022

State of Alaska

AK

Subrecipient Monitoring § 200.303 § 200.332

Finding: 2022-027 ? Department of Education and Early Development staff did not document risk assessments for non-Local Educational Agency (LEA) subrecipients.Questioned Costs: NoneAssistance Listing Number: 84.425D; 84.425UAssistance Listing Title: ESSER ? COVID-19; ARP ESSER Fund ? COVID-19Views o...

Finding: 2022-027 ? Department of Education and Early Development staff did not document risk assessments for non-Local Educational Agency (LEA) subrecipients.Questioned Costs: NoneAssistance Listing Number: 84.425D; 84.425UAssistance Listing Title: ESSER ? COVID-19; ARP ESSER Fund ? COVID-19Views of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): The department agrees with Finding 2022-027.Corrective Action (corrective action planned): Risk assessments for the FY2023 grant year are being done prior to grant payments for all grantees. Program staff have also implemented formal subrecipient monitoring in FY2023.Completion Date (list anticipated completion date): July 30, 2023Agency Contact (name of person responsible for corrective action): Deb Riddle, Division Operations Manager, Division of Innovation and Education Excellence

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Finding 422819 (2022-056)

Significant Deficiency 2022

State of Alaska

AK

Allowable Costs / Cost Principles Special Tests & Provisions Eligibility

Finding: 2022-056 - Certain behavioral health providers were not screened and enrolled in accordance with federal eligibility requirements.Questioned Costs: Assistance Listing 93.767: $1,669; Assistance Listing 93.778: $425,224Assistance Listing Number: 93.767; 93.775, 93.777, 93 .778Assistance List...

Finding: 2022-056 - Certain behavioral health providers were not screened and enrolled in accordance with federal eligibility requirements.Questioned Costs: Assistance Listing 93.767: $1,669; Assistance Listing 93.778: $425,224Assistance Listing Number: 93.767; 93.775, 93.777, 93 .778Assistance Listing Title: CHIP; Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The department is assessing the issues identified in the fmdmg and collaborating internally on the necessary corrective action. It is anticipated multiple courses of action may be necessary and include, among others, strengthening the provider enrollment grid and policies.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2025.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422818 (2022-055)

Significant Deficiency 2022

State of Alaska

AK

Eligibility Significant Deficiency Internal Control / Segregation of Duties

Finding: 2022-055 - Seven of 30 (23 percent) Medicaid eligibility cases and two of 20 (10 percent) CHIP eligibility cases tested were sent written eligibility notices that contained inconsistent or incorrect information regarding the eligibility period and application date.Questioned Costs: NoneAssi...

Finding: 2022-055 - Seven of 30 (23 percent) Medicaid eligibility cases and two of 20 (10 percent) CHIP eligibility cases tested were sent written eligibility notices that contained inconsistent or incorrect information regarding the eligibility period and application date.Questioned Costs: NoneAssistance Listing Number: 93.767; 93.775, 93.777, 93.778Assistance Listing Title: CHIP; Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Public Assistance (DPA) continues to strengthen online staff development and training offerings available in the department?s electronic training portal which include courses on MAGIICHIP Medicaid and ARIES. The agency continues to streamline the Statewide Case Review Team and the case review guidelines reflecting the team?s requirement to spend 80 percent of their time reviewing cases with the goal of increasing timeliness and accuracy. A contractor was secured to serve as the primary resource in addressing Alaska Resource for Integrated Eligibility Services (ARIES) system defects and is assisting in the system?s maintenance and operations. The contractor started defect resolution activities and pushed the first round of defect fixes (Release) into the ARIES Production Environment, 7/8/2022. Defect resolution is an ongoing activity, the Contractor will continue to review and fix existing, as well as any new defects encountered. Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2024.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422817 (2022-052)

Significant Deficiency 2022

State of Alaska

AK

Eligibility Significant Deficiency

Finding: 2022-052 - An examination of the Alaska Resource for Integrated Eligibility Services system during FY 22 identified significant intemal control deficiencies.Questioned Costs: NoneAssistance Listing Number: 93.767; 93.775, 93.777, 93.778Assistance Listing Title: CHIP; Medicaid ClusterViews o...

Finding: 2022-052 - An examination of the Alaska Resource for Integrated Eligibility Services system during FY 22 identified significant intemal control deficiencies.Questioned Costs: NoneAssistance Listing Number: 93.767; 93.775, 93.777, 93.778Assistance Listing Title: CHIP; Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): A contractor was secured to serve as the primary resource in addressing Alaska Resource for Integrated Eligibility Services (ARIES) system defects and is assisting in the system?s maintenance and operations. The contractor started defect resolution activities and pushed the first round of defect fixes (Release) into the ARIES Production Environment, 7/8/2022. Defect resolution is an ongoing activity, the Contractor will continue to review and fix existing, as well as any new defects encountered.Completion Date (list anticipated completion date): The audit finding was fixed in FY2023.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422816 (2022-054)

Material Weakness 2022

State of Alaska

AK

Eligibility Material Weakness

Finding: 2022-054 - Thirty Medicaid and 20 CHIP recipients with paid medical claims during FY 22 were randomly selected for eligibility testing. Auditors found inaccurate or unsupported eligibility determinations by DPA staff for 33 percent of Medicaid cases tested and 10 percent of CHIP cases teste...

Finding: 2022-054 - Thirty Medicaid and 20 CHIP recipients with paid medical claims during FY 22 were randomly selected for eligibility testing. Auditors found inaccurate or unsupported eligibility determinations by DPA staff for 33 percent of Medicaid cases tested and 10 percent of CHIP cases tested.Questioned Costs: Assistance Listing 93.767: $20,115; Assistance Listing 93.778: $16,945Assistance Listing Number: 93.767; 93.775, 93.777, 93.778Assistance Listing Title: CHIP; Medicaid Cluster Views of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DHSS concurs with the finding but not the questioned costs. CMS has notified the state that financial recoveries based on eligibility errors can only be pursued when identified by programs operating under CMS? Payment Error Rate Measurement (PERM) program, under section 1903(u) of the Social Security Act and regulations at 42 CFR Part 431, Subpart Q.Corrective Action (corrective action planned): The Division of Public Assistance (DPA) continues to strengthen online staff development and training offerings available in the department?s electronic training portal which include courses on MAGI/CHIP Medicaid and ARIES. The agency continues to streamline the Statewide Case Review Team and the case review guidelines reflecting the team?s requirement to spend 80 percent of their time reviewing cases with the goal of increasing timeliness and accuracy.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2023.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422815 (2022-053)

Material Weakness 2022

State of Alaska

AK

Eligibility Subrecipient Monitoring Cash Management

Finding: 2022-053 - Thirty Medicaid and 20 CHIP recipients with paid medical claims during FY 22 were randomly selected for eligibility testing. Auditors found DPA staff did not process applications in a timely manner or redetermine eligibility when required for 87 percent of Medicaid cases and 90 p...

Finding: 2022-053 - Thirty Medicaid and 20 CHIP recipients with paid medical claims during FY 22 were randomly selected for eligibility testing. Auditors found DPA staff did not process applications in a timely manner or redetermine eligibility when required for 87 percent of Medicaid cases and 90 percent of CHIP cases tested.Questioned Costs: NoneAssistance Listing Number: 93.767; 93.775, 93.777, 93.778Assistance Listing Title: CHIP; Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Public Assistance (DPA) continues to streamline internal processes, including staff training on the use of the electronic document management system (ILINX) and the Instant Eligibility Verification System (IEVS) to increase accurate and timely eligibility renewals. The department also completed a procurement during FY22 to secure a contractor, who is serving as the primary resource in implementing an automated renewal process. The contract became effective 03/01/2022.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2023.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422814 (2022-051)

Significant Deficiency 2022

State of Alaska

AK

Allowable Costs / Cost Principles Eligibility Subrecipient Monitoring

Finding: 2022-051 - DHSS staff claimed inaccurate federal reimbursement for behavioral health costs.Questioned Costs: Assistance Listing 93.767: Indeterminate; Assistance Listing 93.778: IndeterminateAssistance Listing Number: 93.767; 93.775, 93.777, 93 .778Assistance Listing Title: CHIP; Medicaid C...

Finding: 2022-051 - DHSS staff claimed inaccurate federal reimbursement for behavioral health costs.Questioned Costs: Assistance Listing 93.767: Indeterminate; Assistance Listing 93.778: IndeterminateAssistance Listing Number: 93.767; 93.775, 93.777, 93 .778Assistance Listing Title: CHIP; Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Behavioral Health (DBH) is working with the ASO to ensure accurate member eligibility file load and claims processing issues under a corrective action plan to resolve issues that led to inaccurate federal reimbursement.Completion Date (list anticipated completion date): DOH anticipates an interim resolution will be in place during FY2023 followed with a full system resolution in FY2024.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422813 (2022-050)

Significant Deficiency 2022

State of Alaska

AK

Allowable Costs / Cost Principles

Finding: 2022-050 - Testing of 40 behavioral health claims paid during FY 22 identified 27 (68 percent) with errors:? Three providers were not enrolled in the Medicaid program at the time medical services were rendered.? Three providers that billed for and received payment for the claims were not as...

Finding: 2022-050 - Testing of 40 behavioral health claims paid during FY 22 identified 27 (68 percent) with errors:? Three providers were not enrolled in the Medicaid program at the time medical services were rendered.? Three providers that billed for and received payment for the claims were not associated with the individual medical provider that rendered the medical services.? Three claims were paid even though the claims were submitted with an incorrect National Provider Identifier. The providers were validly enrolled.? Thirteen claims did not identify the provider who rendered medical services. State regulations specifically outline requirements for providers who are qualified to render the services.? Five claims identified the provider who rendered the medical service, but the provider had not met qualification requirements.Questioned Costs: Assistance Listing 93.767: None; Assistance Listing 93.778: $1,406Assistance Listing Number: 93.767; 93.775, 93.777, 93.778Assistance Listing Title: Children?s Health Insurance Program (CHIP); Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Behavioral Health (DBH) is working with the ASO to ensure accurate load of provider information into the Facets Medicaid Management Information System (MMIS) and implement routine monitoring procedures, including quarterly sampling, of paid claims.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2023. Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422812 (2022-047)

Significant Deficiency 2022

State of Alaska

AK

Matching / Level of Effort / Earmarking

Finding: 2022-047 - Internal controls over FY 22 LIHEAP earmarking requirements for planning and administrative costs were ineffective.Questioned Costs: NoneAssistance Listing Number: 93.568Assistance Listing Title: LIHEAPViews of Responsible Officials (state whether your agency agrees or disagrees ...

Finding: 2022-047 - Internal controls over FY 22 LIHEAP earmarking requirements for planning and administrative costs were ineffective.Questioned Costs: NoneAssistance Listing Number: 93.568Assistance Listing Title: LIHEAPViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding. Corrective Action (corrective action planned): The Division of Public Assistance plans to review all current LIHEAP earmarking procedures to identify areas for improvement. A formal training plan for staff will be developed to ensure compliance measures are being understood and met.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2024.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Finding 422811 (2022-046)

Significant Deficiency 2022

State of Alaska

AK

Questioned Costs Eligibility Significant Deficiency

Finding: 2022-046 - Three (5 percent) of 60 Low-Income Home Energy Assistance Program (LIHEAP) applicant case files tested had eligibility errors.Questioned Costs: $6,490Assistance Listing Number: 93.568Assistance Listing Title: LIHEAPViews of Responsible Officials (state whether your agency agrees ...

Finding: 2022-046 - Three (5 percent) of 60 Low-Income Home Energy Assistance Program (LIHEAP) applicant case files tested had eligibility errors.Questioned Costs: $6,490Assistance Listing Number: 93.568Assistance Listing Title: LIHEAPViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Public Assistance (DPA) plans to implement random sample testing for LIHEAP cases using the Program Integrity and Analysis Unit. This would reflect current processes in place for similar public assistance programs that the division administers.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2024.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

View Audit 312347 Questioned Costs: $1

Finding 422810 (2022-049)

Material Weakness 2022

State of Alaska

AK

Reporting Internal Control / Segregation of Duties Subrecipient Monitoring

Finding: 2022-049 - Auditors could not obtain sufficient and appropriate evidence to verify accuracy of the data reported in the FFY 21 LIHEAP Performance Data Form and the FFY 21 Annual Report on Households Assisted by LIHEAP. In addition, the SF-425 LIHEAP financial report for the FFY 21 grant awa...

Finding: 2022-049 - Auditors could not obtain sufficient and appropriate evidence to verify accuracy of the data reported in the FFY 21 LIHEAP Performance Data Form and the FFY 21 Annual Report on Households Assisted by LIHEAP. In addition, the SF-425 LIHEAP financial report for the FFY 21 grant award misreported two of six key line items. One line was misstated by $1,189,130, and the second by $689,186.Questioned Costs: NoneAssistance Listing Number: 93.568Assistance Listing Title: LIHEAP Views of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Public Assistance plans to review all current LIHEAP compliance procedures to identify areas for improvement. The agency?s support units will coordinate efforts to research any issues that may be causing inaccuracy in data being reported. Development and coordination of procedures with the DFMS team will also be prioritized to ensure requirements are met.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2024.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

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Corrective Action Plans

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