Finding Text
Condition:
El Dorado County Community Health Center lacked adequate controls over its sliding fee discount program to ensure applications were properly processed, recorded, and received the correct discount. For one of 40 patient files reviewed who received a sliding fee discount, the patient was not eligible for a sliding fee discount. For one of the 40 patient files reviewed who received a sliding fee discount, the patient’s income was not documented in accordance with the policy before moving forward with determination of sliding fee discount and no supporting documentation regarding the hardship was included on the application.
Criteria:
El Dorado County Community Health Center must have a policy and processes in place to ensure that eligible patient charges are adjusted based on the patient’s ability to pay (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)).
Cause:
El Dorado County Community Health Center did not properly follow the review process in place to verify that eligible patients received the applicable sliding fee discount according to the Organization’s policy.
Effect:
El Dorado County Community Health Center's sliding fee program was not operating in accordance with the Organization's policies and federal regulations.
Recommendation:
We recommend El Dorado County Community Health Center review their sliding fee process and provide additional training to individuals regarding the process. In addition, we recommend El Dorado County Community Health Center implement a review process to identify errors that may occur.
View of Responsible Officials
Management acknowledges this condition related to lack of adequate controls over the sliding fee discount program and is creating controls that will assure compliance with requirements.