Finding Text
2022-001 Special Tests and Provisions ? Sliding Fee Discounts Major Program ? Health Center Program Cluster Assistance Listing Number ? 93.224 Federal Agency ? U.S. Department of Health and Human Services Finding Type ? Significant Deficiency Criteria or Specific Requirement ? Special Tests and Provisions ? In accordance with Health Resources & Services Administration Health Center Program Manual, Chapter 9: Sliding Fee Discount Program and 42 CFR sections 51c.303(e), (f) and (g), health centers must prepare and apply a sliding fee discount schedule so that the amounts owed to health center services by eligible patients are adjusted based on the patient?s ability to pay. No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the Federal Poverty Guidelines (FPG). Condition ? In a sample of tested encounters, patient information was inadequate to determine whether the proper sliding fee discount was applied. Questioned Costs ? None. Context ? Out of 40 encounters sampled, the following was identified: (1) For 3 out of 40, the Organization failed to perform recurring verification of income, allowing some patients who have never formally applied or may have updated income that would have changed the sliding fee discount to have a reduced charge. (2) For 7 out of 40, the Organization obtained verbal verification of income and no formal verification or proof of income was obtained prior to the Organization providing services; and (3) For 3 out of 40, the patient was registered properly as a Medicaid patient but was subsequently improperly transferred to a sliding fee and no application or verification of income was obtained. The sampling was not a statistically valid sample. Effect ? As a result, 13 patients received the sliding fee discount without the proper documentation to support that they were eligible for the discount or received the appropriate level of discount based on income. Cause ? The inaccuracies in the application of the sliding fee program discounts appear to be due to inadequate oversight and review. Repeat Finding ? Yes; 2021-003, 2020-003 Recommendation ? The Organization should strengthen processes surrounding monitoring of the program to ensure that the Organization?s policies are consistently and properly applied. Management should periodically audit the sliding fee encounters for appropriate discount determination. Views of Responsible Officials and Planned Corrective Actions ? Management will ensure that adequate documentation is maintained to support the sliding fee discount and documentation used to calculate the discount is reviewed by a supervisor.