Finding Text
Health Center Program Assistance Listing Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 2 H80CS00715-23-00 Program Year 24 Criteria or specific requirement – Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g); and 42CFR sections 56.303 (f)) Condition – Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy. Cause – The Organization did not comply with their sliding fee policy. Effect or potential effect – Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee discount policy. Questioned costs – None Context – A sample of 25 patients were tested out of the total population of 144,957 encounters. The sampling methodology used is not and is not intended to be statistically valid. Four patients received a sliding fee adjustment that was inconsistent with the approved policy based on their income documentation. Identification as a repeat finding – Not a repeat finding Recommendation – We recommend management continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Health Center Program Compliance Manual. Views of Responsible Officials and Planned Corrective Actions – Management's action plan to improve compliance includes an audit of EPIC to assure that the slide fee categories are loaded and functioning in accordance with the Primary Health Care Sliding Fee Discount Policies, modify EPIC accordingly and correct the system generated “auto-slide” issue, to be led by Beth Frantum, Chief Financial Officer to be completed in November 2025. Beth will then update resource materials and distribute them to the necessary staff. Beth will develop and implement an internal review process to provide reasonable assurance that slide fee category calculations are accurate and EPIC reflects the correct amount expected for services.