Finding 3846 (2023-002)

2023-002 – Significant Deficiency and Noncompliance – Special Tests – Sliding Fee Program information: AL # 93.224 and 93.527, Health Center Program Cluster, Department of Health and Human Services. Criteria: Health centers must obtain sliding fee applications so that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: We tested 40 sliding fee encounters and noted that 4 of 40 sliding fee encounters were discounted the incorrect amount, 2 of 40 were missing sliding fee applications, and 1 or 40 had an incomplete application. In addition, we noted the sliding fee policy stated that a household should consist of immediate family members living in the same dwelling, however, applications included all individuals living in the household, whether immediate or not. Questioned Costs: None Cause and Effect: The Organization failed to verify sliding fee applications were obtained for all patients receiving discounts and may have incorrectly charged sliding fee discounts to charges. Recommendation: We recommend that sliding fee applications be completed for each sliding fee patient. Procedures should be implemented to verify applications are completed before the encounter is billed. Sliding fee discounts should be properly calculated and applied. The Organization should consider internal sampling throughout the year to verify sliding fee applications are obtained, completed, and agree to the discount applied. Lastly, sliding fee policy and applications should be modified to be consistent in the treatment of household members. Views of Responsible Officials: Management agrees with the finding. Corrective Action Plan: See attached correct plan.