Finding Text
2025-001 Sliding Scale Determination Special Tests and Provisions ALN 93.224 Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) US Department of Health and Human Services Contract Numbers H80CS30749-08, H80CS30749-09, and H8NCS54017-01-02 Contract Periods April 1, 2024 – March 31, 2025 and April 1, 2025 – March 31, 2026 and September 1, 2024 – August 31, 2025 Conditions and Criteria: The requirements under 42 CFR 51c.303(f) provide requirements to have prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient's ability to pay. Provided, that such schedule of discounts shall provide for a full discount to individuals and families with annual incomes at or below those set forth in the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2); and for no discount to individuals and families with annual incomes greater than twice those set forth in such Guidelines, except that nominal fees for services may be collected from individuals with annual incomes at or below such levels where imposition of such fees is consistent with project goals. In the 2025 audit, for 2 of 40 samples selected for testing, OCHS calculated the sliding scale level incorrectly based on income and family size documentation. Effect: The effect is that two patient’s sliding scale levels were calculated incorrectly and their fees were incorrectly applied. Cause: Determining a patient’s sliding fee discount level is to be performed on an annual basis. During the 2025 fiscal year, OCHS had employee turnover in the compliance department. Although OCHS has policies in place for calculating patient sliding scale level determination based on income and family size, the calculations were performed incorrectly due to a lack of monitoring in place to ensure the requirement under 42 CFR 51c.303(f) was adhered to. Auditor Recommendation: We recommend that a procedure should be put in place to monitor whether the calculation in sliding scale levels are correctly calculated and applied per patient documentation. Planned Corrective Action: See the following Corrective Action Plan section for management’s planned corrective action.