Finding 1925 (2023-001)

Health Center Program Cluster - CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS00803-22-01 Program Year 2023 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 stated sliding fee discount categories under the Organization’s policy. Questioned cost – None Context – A sample of 25 encounters were tested and 2 errors were noted where patients received an incorrect sliding fee adjustment. The sampling methodology used is not intended to be statistically significant. Two patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documentation. Effect – Sliding fee discounts adjustments given to patients that were inconsistent with the Organization’s sliding fee discount policy. Cause – The Organization’s new practice management system was not initially set-up to allow the Organization to comply with their sliding fee policy. Identification as a repeat finding, if applicable – Is not a repeat finding. Recommendation – We recommend management ensure the new practice management system is reviewed and updated to ensure it properly calculates appropriately sliding fee adjustments based on patient income and family size criteria. We also recommend 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.