Finding 1168502 (2025-001)

Material Weakness Repeat Finding
Requirement
AB
Questioned Costs
-
Year
2025
Accepted
2026-01-08
Audit: 380315
Organization: Sma Healthcare, Inc. (FL)

AI Summary

  • Core Issue: Several clients' Financial Assessment Forms (FAFs) were either incomplete or improperly calculated, leading to potential noncompliance.
  • Impacted Requirements: FAFs must be completed accurately and updated yearly for clients with active services, ensuring all service dates align with the FAF completion date.
  • Recommended Follow-Up: Update processes to ensure FAFs are fully completed and accurate, and implement additional controls for documenting discount rates.

Finding Text

2025-001 – ALN 93.958 – Block Grant for Community Mental Health Services; ALN 93.959 – Block Grant for Prevention and Treatment of Substance Abuse; ALN 93.788 Opioid STR Program: Activities Allowed/Allowable Costs - Completion of Financial Assessment Form – (Repeat Comment) Criteria: The Block Grant for Community Mental Health Services and the Block Grant for Prevention and Treatment of Substance Abuse provide for a set of documentation requirements for clients in the covered programs, including the completion of a Financial Assessment Form (FAF) to document financial eligibility over allowable costs. Based on the client’s income and number of dependents, this form is used to determine a “discount class”, and calculate a sliding scale discount percentage and/or dollar amount of SMA’s fees that the client would be responsible for paying. This form is required to be completed when clients are discharged after being provided mental health services. FAF are to be updated yearly for patients with active billable services, noting all service dates with a billed service should fall within one year of the FAF completion date. Condition: 3 of the 60 clients tested on the Block Grant for Community Mental Health Services did not have the discount fee that was used properly calculated and documented on their Financial Assessment Form. Additionally, 4 of the 60 clients tested on the Block Grant for Community Mental Health Services had service dates that did not fall within one year after the FAF completion date. 1 of the 60 clients tested on the Block Grant for Prevention and Treatment of Substance Abuse and 1 of 40 clients tested on the Opioid STR Program did not have a completed FAF. 1 of the 60 clients tested on the Block Grant for Prevention and Treatment of Substance Abuse had a FAF missing the client signature. Cause: The requirement to perform these control elements were not followed by the case managers. Effect: The Financial Assessment Forms that were not properly completed or not completed within the required timeframe could result in noncompliance with the grant agreement or noncompliance with established controls. Recommendation: We recommend that the process be updated to ensure all Financial Assessment Forms required be completed fully and accurately for all patients within one year of service, and that additional controls be put in place to ensure the discount rate applied is documented and proper.

Corrective Action Plan

For ALN 93.958, the discount fee was not properly calculated and/or documented on the Financial Assessment Form for 3 of the 60 clients tested. Additionally, 4 of the 60 clients tested on the Block Grant for Mental Health had dates that did not fall within one year after the FAF completion. For ALN 93.959, 1 of the 60 clients tested on the Block Grant for Prevention and Treatment of Substance Abuse did not have a completed FAF and 1 of the 60 tested had a missing client signature. For ALN 93.788, 1 of the 40 clients tested on Opioid STR Program did not have a completed FA. Our internal tracking of completion of the Financial Assessment Form at admission indicates that compliance with this requirement occurs about 90% of the time. We have identified that some of the missing FAs are a result of Telehealth appointments and clients not coming into the office. As a corrective action, the Client Service Specialist will be trained by their managers to ensure data is entered accurately and how to properly apply the FAs. SMA will also include the completion of the Financial Assessment Form both at admission and annually with data to be reviewed monthly by the managers. In addition, we will be working with IT to identify a way to collect the FAs from clients that utilize Telehealth services. Reporting will be sent out monthly and if out of compliance the managers will be required to be present at the quarterly Quality Assurance Committee meeting if not at 100%.

Categories

Allowable Costs / Cost Principles Eligibility

Other Findings in this Audit

  • 1168480 2025-001
    Material Weakness Repeat
  • 1168481 2025-001
    Material Weakness Repeat
  • 1168482 2025-001
    Material Weakness Repeat
  • 1168483 2025-001
    Material Weakness Repeat
  • 1168484 2025-001
    Material Weakness Repeat
  • 1168485 2025-001
    Material Weakness Repeat
  • 1168486 2025-001
    Material Weakness Repeat
  • 1168487 2025-001
    Material Weakness Repeat
  • 1168488 2025-001
    Material Weakness Repeat
  • 1168489 2025-001
    Material Weakness Repeat
  • 1168490 2025-001
    Material Weakness Repeat
  • 1168491 2025-001
    Material Weakness Repeat
  • 1168492 2025-001
    Material Weakness Repeat
  • 1168493 2025-001
    Material Weakness Repeat
  • 1168494 2025-001
    Material Weakness Repeat
  • 1168495 2025-001
    Material Weakness Repeat
  • 1168496 2025-001
    Material Weakness Repeat
  • 1168497 2025-001
    Material Weakness Repeat
  • 1168498 2025-001
    Material Weakness Repeat
  • 1168499 2025-001
    Material Weakness Repeat
  • 1168500 2025-001
    Material Weakness Repeat
  • 1168501 2025-001
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.788 OPIOID STR $1.22M
93.696 CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC EXPANSION GRANTS $976,503
93.211 TELEHEALTH PROGRAMS $631,757
93.243 SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES PROJECTS OF REGIONAL AND NATIONAL SIGNIFICANCE $503,746
93.767 CHILDREN'S HEALTH INSURANCE PROGRAM $283,167
93.558 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES $243,411
93.912 RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK DEVELOPMENT AND SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT $222,494
93.959 BLOCK GRANTS FOR PREVENTION AND TREATMENT OF SUBSTANCE ABUSE $204,633
93.997 ASSISTED OUTPATIENT TREATMENT $171,756
16.738 EDWARD BYRNE MEMORIAL JUSTICE ASSISTANCE GRANT PROGRAM $56,062
14.235 SUPPORTIVE HOUSING PROGRAM $50,288
97.032 CRISIS COUNSELING $31,148
93.136 INJURY PREVENTION AND CONTROL RESEARCH AND STATE AND COMMUNITY BASED PROGRAMS $27,000
93.958 BLOCK GRANTS FOR COMMUNITY MENTAL HEALTH SERVICES $10,652
14.231 EMERGENCY SOLUTIONS GRANT PROGRAM $-16,239