Finding Text
Finding No.: 2023-002 Area: CFDA 93.224 Health Center Grant Inability to Verify Compliance with Sliding Fee Discount Requirements Criteria: Under the Health Center Program (CFDA 93.224), health centers are required to implement and apply a sliding fee discount schedule (SFDS) to adjust patient charges based on income and family size, ensuring access to affordable healthcare services for low-income individuals. The sliding fee discounts must be applied in accordance with the health center’s approved schedule. In addition, 45 CFR Part 75, Appendix XI (Compliance Supplement) requires auditors to review the sliding fee discount schedule and a sample of patient financial records to verify that discounts are appropriately calculated and applied based on income and family size. Condition: This finding was reported in the prior year and the same condition continued during the current audit period. During our fieldwork at Yap State Hospital, we noted that income eligibility determinations were not performed for patients as required by the grantor. The hospital treated the entire Yap State population as being below the poverty level, resulting in all patients automatically qualifying for sliding fee discounts. Documentation provided by Yap State Government (YSG) and the health center was limited to cash receipts reports. These reports did not include sufficient patient-level financial information, such as income and family size, to allow verification that sliding fee discounts were applied in accordance with program requirements. Cause: The health center did not provide the required patient financial records for services rendered during the audit period. Effect: Because patient financial records were not made available, we were unable to determine whether the health center complied with the sliding fee discount requirements of the Health Center Program. This condition increases the risk that patient charges may not be accurately or consistently adjusted, potentially limiting affordability for low-income patients and resulting in noncompliance with federal program requirements. Recommendation: We recommend that YSG work closely with the health center to establish and enforce procedures for the timely and complete submission of patient financial records for audit and compliance purposes. The health center should ensure that adequate documentation is maintained to support income and family size determinations and the proper application of sliding fee discounts. If necessary, YSG should seek guidance from the federal awarding agency to ensure compliance with program requirements. In addition, Yap State Government health centers should immediately develop, implement, and document a comprehensive Sliding Fee Discount Schedule in accordance with applicable federal regulations. Schedule of Findings and Questioned Costs, Continued Year Ended September 30, 2023 Finding No.: 2023-002 Area: CFDA 93.224 Health Center Grant Inability to Verify Compliance with Sliding Fee Discount Requirements Identification as a Repeat Finding: Yes Views of Responsible Officials: The State agreed with the finding. See the response and planned corrective actions in the Corrective Action Plan following the Schedule of Findings and Questioned Costs.