Finding 1103427 (2024-001)

Finding 2024.001: Special Tests and Provisions - Sliding Fee Scale Discounts - Significant Deficiency Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless and Public Housing Primary Care) Grants for New and Expanded Services Under the Health Center Program COVID-19 Grants for New and Expanded Services Under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H8012843 - 2023 and 2024, H8L51743 - 2023 and H8G48165 - 2022 Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5),56.108(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate and review slide fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition The Center did not always calculate the proper sliding fee discount based on the Center's approved sliding fee discount policy or have the appropriate documentation. Cause The Center did not have adequate internal controls in place to effectively ensure that the patient received the correct sliding fee discount based on the Center's approved sliding fee discount policy. Effect or Potential Effect The Center did not comply with the appropriate Special Tests and Provisions rules and regulations as per the Uniform Guidance. Questioned Costs None Context A test of 40 slide fee discount transactions was performed and resulted in four instances of sliding fee discounts not being properly calculated based on the respective household size and income. For one of these instances, there was no sliding fee application. Our sample was a statistically valid sample. Identification of Repeat Finding Yes, see finding 2023.001 Recommendation The Center should establish a system of internal controls to ensure that all patients receive the correct sliding fee discount. Views of Responsible Officials Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.