Finding 1229166 (2025-003)

Health Center Program Cluster Assistance Listing 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 2 H80CS26560-12-00 Criteria or Specific Requirement: Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303 (f)) Condition: Patients received a sliding fee discount that was inconsistent with the documented sliding fee discount categories under the Organization's Policy. In addition, the Organization did not update the sliding fee scale for annual changes to the poverty guidelines timely. Cause: The Organization did not comply with its sliding fee policy. Effect or Potential Effect: Incorrect sliding fee discounts were given. Questioned Costs: None Context: A sample of 40 patients was tested out of the total population of 1,452 encounters and 11 errors were noted where patients received an incorrect sliding fee adjustment. The sampling methodology used is not and is not intended to be statistically valid. Identification as a Repeat Finding: Repeat Finding of 2024-003 Recommendation: We recommend that management continue to ensure that 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. In addition, management should ensure the Organization's sliding fee scale is updated annually in accordance with federal guidelines.