Finding 1218801 (2025-002)

Program Information: U.S. Department of Health and Human Services Tribal Self-Governance and Determination Cluster Assistance Listing #93.441 Award Numbers: HHS-I-241-2022-00004 and HHS-I-241-2019-00003 Award Period: 10/1/2024-9/30/2027 and 10/1/2020-9/30/2021 Rural Health Outreach and Rural Network Development Program Assistance Listing #93.912 Award Numbers: 6 G28RH46294-03-00 and 6 HB1RH47073-03-02 Award Period: 9/30/2022-9/29/2025 and 9/1/2022-8/31/2026 Criteria: Assistance Listing #93.441 Per the compliance supplement and 42 CFR 136.12, eligible individuals include those of Indian descent belonging to the local Indian community, as evidenced by tribal membership or similar factors. Additional eligibility covers non-Indian women pregnant with an eligible Indian’s child, certain non-Indian household members for public health reasons, and specific children and spouses per 25 USC 1680c(a)-(b) and Section 813 of the Indian Health Care Improvement Act. For Purchased/Referred Care (PRC), individuals must reside in the U.S. within a PRC Delivery Area, be a member of or have close ties to the relevant tribe(s), and meet requirements for students, transients, and foster children as specified in the supplement. Assistance Listing #93.912 Per discussion with the program’s Chief Behavioral Health Officer, individuals must provide documentation of membership in a federally recognized Tribe (e.g., Tribal enrollment card, Certificate of Indian Blood, or proof of lineal descent) and a signed consent to receive services. Registration staff are responsible for screening and securely filing these documents in the practice management system. Per 2 CFR § 200.303, recipients must establish and maintain effective internal controls over federal awards to ensure compliance with applicable regulations. Condition/Context: Assistance Listing #93.441 Of the 60 samples selected for testing, documentation to evidence review and approval was not provided. Assistance Listing #93.912 Of the 5 samples selected for testing, documentation to evidence review and approval was not provided. [ ] Compliance Finding [ X ] Significant Deficiency [ ] Material Weakness Cause: The program did not have adequate internal controls to ensure that all eligibility files included documentation of review and approval. This appears to be due to a lack of oversight and monitoring procedures to track compliance with this documentation requirement. Effect: Without adequate documentation of review and approval, there is an increased risk that ineligible individuals may receive services, and the entity may not be able to demonstrate compliance with federal eligibility requirements. This could result in questioned costs or findings in future audits. Questioned Cost: N/A – none of the samples selected for testing were determined to be ineligible to receive services. Prior Year Finding: Yes, 2024-004. Recommendation: We recommend that management implement and enforce procedures to ensure that all eligibility determinations are reviewed and approved, and that supporting documentation of such review and approval is consistently maintained in the appropriate system or file. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding and has prepared corrective action as detailed in its Corrective Action Plan.