Finding 35125 (2022-003)

-
Requirement
A
Questioned Costs
$1
Year
2022
Accepted
2022-12-15
Audit: 32577
Organization: South Lyon Health Center, INC (NV)
Auditor: Wipfli LLP

AI Summary

  • Core Issue: The Medical Center claimed $1,226,613 for an HVAC project that was not completed by the required deadline, leading to noncompliance with funding rules.
  • Impacted Requirements: Costs for capital projects must be fully completed by the end of the funding period to be reimbursable, as clarified in updated FAQs after the reporting period.
  • Recommended Follow-Up: Management should establish procedures to ensure that grant funds are only used for allowable costs within the specified timeframes.

Finding Text

Finding 2022.003 Program Name/CFDA Title: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Noncompliance Compliance Requirement: Allowable Costs Questioned Costs: $1,226,613 Condition: In Provider Relief Fund reporting period 1, the Medical Center reported expenditures of $1,226,613 related to a HVAC capital project that was not yet complete and placed into service by the end of the period of availability, June 30, 2021. Criteria: The Provider Relief Fund Frequently Asked Questions (FAQs) state ?For projects that are a bundle of services and purchases of tangible items that cannot be separated, such as capital projects, construction projects, or alteration and renovation projects, the project costs cannot be reimbursed using Provider Relief Fund payments unless the project was fully completed by the end of Period of Availability associated with the Payment Received Period.? This language was added to the FAQs after the end of the period 1 period of availability, on August 30, 2021. Context: During the audit, it was determined that one HVAC capital project tested using Provider Relief Funds was not completed within the period of availability. Cause: The Provider Relief Fund Post-Payment Notice of Reporting Requirements state that updates to HVAC systems are an allowable use of the funds. The Medical Center entered into an agreement with a contractor on May 5, 2021, but the project was not fully completed by the end of the Period of Availability as required by the Provider Relief Fund FAQs. Effect: Expenditures were claimed in reporting period 1 for a capital project that was not complete by the end of the Period of Availability, resulting in a reportable finding. Recommendation: Management should implement procedures to ensure grant funds are expended as needed for allowable costs during the applicable periods of availability. View of Responsible Officials The Medical Center entered into an agreement on May 5, 2021 for an HVAC update, which is an allowable cost per the Post-Payment Notice of Reporting Requirements. The FAQs available at the time the contract was executed did not include a requirement that the capital project be fully complete by the end of the Period of Availability to be allowable. This requirement was added on August 30, 2021, which is two months after the end of the period 1 Period of Availability, June 30, 2021. HVAC projects at hospitals require a significant amount of time to plan, design, and build under normal circumstances, even before taking into consideration complications added by the pandemic, which included contractor shortages, labor availability issues, and supply chain issues. The Medical Center in good faith entered into the contract, and committed funds to the project, using the guidance available at the time of the commitment. The project was part of the Medical Center?s initiative to prevent, prepare for, and respond to coronavirus and, accordingly, the Provider Relief Fund grants were used to help fund the initiative.

Corrective Action Plan

Finding # 2022-003 Response South Lyon Medical Center received the provider relief funds in May 2020. Immediately after award, and using HRSA?s authorized usage of the funds, Administration reviewed weaknesses in the facility needed to mitigate the COVID19 pandemic. After due diligence and several meetings on the funding guidelines, SLMC determined the greatest benefit to the community and patients was to upgrade the original HVAC system in its 1963 skilled nursing facility as the most effective way for SLMC to prevent, prepare for, and respond to coronavirus. The facility?s architect/engineer was immediately tasked with the creation of a feasibility report and design plans to perform the needed upgrades, removing the 1963 antiquated system and replacing it with a modern efficient system and the process of finding a contractor to complete the project. In October 2020, plans were completed and submitted to contractors in the surrounding area in pursuit of a proposal. The project was awarded to Miles Construction in March 2021 and a contract was signed on May 5th, 2021. HVAC projects at hospitals require a significant amount of time to plan, design, and build under normal circumstances, even before taking into consideration complications added by the pandemic, which included contractor shortages, labor availability issues, and supply chain issues. These obstacles are much more pronounced in rural areas. There were additional delays in receiving State approval due to the increased number of projects submitted for review to the state during this period. The Medical Center committed funds to the project and entered into the contract in good faith, using the guidance available at the time of the commitment. The project was part of the Medical Center?s initiative to prevent, prepare for, and respond to coronavirus and, accordingly, the Provider Relief Fund grants were used to help fund the initiative. The FAQs available at the time the contract was executed did not include a requirement that the capital project be fully complete by the end of the Period of Availability to be an allowable use of the funds. This requirement was added on August 30, 2021, which is two months after the end of the period 1 Period of Availability, June 30, 2021. Responsible Party David Bezard, CFO South Lyon Health Center, Inc. Estimated Completion The Project was completed and put into service in September 2022 after the Fire Marshall?s final inspection and the Contractor/Architect signed off on the project?s completion.

Categories

Questioned Costs Procurement, Suspension & Debarment Allowable Costs / Cost Principles Reporting

Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund $4.18M
93.697 Covid-19 Testing for Rural Health Clinics $135,588
93.301 Small Rural Hospital Improvement Grant Program $84,029
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $19,448