Finding 32907 (2022-001)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-09-29
Audit: 29396
Organization: Regional Health Reach, Inc. (NY)

AI Summary

  • Core Issue: The Company failed to collect necessary paperwork to verify patients' income and family size, impacting compliance with federal regulations.
  • Impacted Requirements: The lack of documentation means the Company cannot confirm if patient charges were adjusted according to the sliding fee discount schedule.
  • Recommended Follow-Up: Implement a process to ensure all patients complete required paperwork to verify income and family size for proper charge adjustments.

Finding Text

Federal Program: 93.224 Health Center Program Cluster Federal Agency: U.S. Department of Health and Human Services Criteria: Under 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 for health center services by eligible patients are adjusted based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. The Company should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying the Company's sliding fee discount schedule. Condition: The Company did not require patients to complete necessary paperwork to verify the patient?s income and family size. Cause: The Company was unable to provide documentation that supported patient?s income and family size. As such, we are unable to determine whether the Company appropriately adjusted charges in accordance with its sliding fee discount schedule. Effect: The Company is not in compliance with federal regulations. Prevalence: The Company was unable to provide supporting documentation for 6 out of 25 patients sampled. Repeat Finding: Yes

Corrective Action Plan

Management agrees with the finding. Deficiencies in the Sliding Fee Discount program for year ending December 31, 2022 are a direct result of several misfortunes. On top of the COVID pandemic, the organization experienced Unionization, de-Unionization, high staff turnover, including multiple changes in Senior Leadership, a death of an Executive Director, and an office relocation. Since January 2023, significant improvements have been implemented; the office settled into the new location, new staff and senior leaders have been hired, the organization is flourishing post-pandemic, and policies and procedures have been reviewed and updated. After review of the Sliding Fee Discount Program policies and office process, it was clear that previous controls were ineffective and identified gaps in the Sliding Fee Discount program structure. A major gap was the lack of knowledge related to who was in the current program and who continues to be eligible a year after acceptance. This gap was directly related to missing documentation, lack of EMR tracking, and lack of reporting. The previous corrective action for shelter, Street Medicine and Dental teams remains in place; providers who see patients? offsite were trained on the required documentation, which will be submitted to the clinic daily. Additional staff have been assigned to shelters to facilitate the registration process and transportation of the completed forms back to the Clinic for scanning. In mid-February 2023, an audit was completed on the Sliding Fee Discount program to determine clinic compliance. Additional gaps were identified which led to a secondary process of checks and balances. In addition to the current corrective action, a secondary corrective action was implemented. The Clinic staff would collect the application, review eligibility, and enter the approval/denial status, along with the date into the patients EMR, as well as entering the data on a spreadsheet to track yearly eligibility review. In addition, each team is equipped with a draft application that identifies the necessary information for a complete application. The controls currently in place are performed to identify eligibility at each appointment. If no change, the application is then filed until the next appointment or annual review date, whichever occurs first. If a patients income has changed, prior to the yearly review, a new application is completed at the time of visit, the EMR and spreadsheet are updated accordingly, and the application is filed. The current controls are reviewed daily in order to identify eligibility review and compliance.

Categories

Eligibility

Other Findings in this Audit

  • 609349 2022-001
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $1.47M
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $98,873
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $3,276