Finding Text
2026-005 Special Tests and Provisions Program Information Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 Health Center Program Cluster Award Numbers H80CS00513 Criteria [X] Compliance Finding [X] Significant Deficiency [ ] Material Weakness Special Tests and Provisions requires compliance with the program-specific sliding fee discount requirements. The underlying Health Center Program criteria are Section 330(k)(3)(G) of the Public Health Service Act; 42 U.S.C. § 254b(k)(3)(G); and 42 CFR § 51c.303(f), (g), and (u). This finding appears to be an isolated problem. Condition For one item, the patient’s income and family size placed the patient in discount tier B, but the incorrect discount category was applied. Cause The Organization did not have adequate controls to ensure sliding fee discounts were accurately applied. Specifically, staff did not consistently select the correct discount tier, and management did not timely review discounted accounts to confirm patient charges agreed to the approved sliding fee discount schedule. Effect Failure to properly calculate and apply sliding fee discounts may result in patient charges that do not align with federal requirements or the approved sliding fee schedule, potentially leading to incorrect patient responsibility amounts. Context In a sample of 40 patient encounters selected with sliding fee discount, we noted one selection who had the incorrect sliding fee applied. Recommendation We recommend that management strengthen controls over the sliding fee process by requiring supervisory review of income documentation, family size, and discount-level determinations before billing; periodically reconciling billed amounts to the approved sliding fee schedule; documenting reassessments at required intervals; and training billing and intake personnel on the current sliding fee requirements. Views of responsible officials and planned corrective action Management is in agreement with this finding and will take corrective action as outlined on page 35.