FAC Explorer

Finding 386100 (2023-005)

Significant Deficiency
Requirement
B
Questioned Costs
-
Year
2023
Accepted
2024-03-27
Audit: 298480
Organization: Shelby County, Tn (TN)
Auditor: Watkins Uiberall PLLC

AI Summary

  • Core Issue: The Shelby County Ryan White HIV/AIDS program is not aligning services with required definitions, leading to ongoing noncompliance.
  • Impacted Requirements: Compliance with RWHAP Part A legislation and HRSA recommendations is critical to maintain funding.
  • Recommended Follow-Up: Collaborate with HRSA to implement corrective actions addressing service category allocation issues.

Finding Text

Department of Health and Human Services: HIV Emergency Relief Project Grants (Ryan White HIV/AIDS Program Part A) – Assistance Listing No. 93.914; Contract No. CA191064 Criteria: RWHAP Part A legislation, sections 2601-2610 of title XXVI of the Public Health Service Act, 42 U.S.C. 300ff-11-300ff-20. PCN 16-02. Condition: Per the site visit report issued by the Health Resources and Services Administration (HRSA) covering the visit from August 1, 2022 to August 5, 2022, the Shelby County Ryan White HIV/AIDS program (assistance listing number 93.914) was not in compliance with aligning services with the definitions for service categories during the budget period covering March 1, 2021 to February 28, 2022. As the report has not been closed, the issue still exists. No additional compliance issues were identified in the audit of compliance with each major program and on internal control over compliance required by the Uniform Guidance. Cause: Significant turnover within the Shelby County Health Department since the last time this program was audited. The findings are from 2021 and prior, which proceeded Dr. Michelle Taylor (Director-Health Officer), Tammy Winston (Finance Administrator), and Travis Green (Deputy Division Director). Effect: Continued noncompliance with recommendations from the HRSA could lead to potential decreases in funds received. Recommendation: We recommend working with the HRSA to implement appropriate corrective action to remedy their concerns with the allocation of activity to specific service categories. View of Responsible Officials: See management’s corrective action plan.

Corrective Action Plan

Rosita Timmons, Deputy Administrator, is currently working with the Project Officer, Jennifer Gray, to gain a better understanding of the finding and the changes necessary to comply with the site visit report. In prevoius conversations with Melody Berry, former project officer, during 2023, the changes were considered acceptable. The department was moving forward with the plan to update duties. After discussing the logistics of adding Non-Medical Case Management, it was determined by the Planning Council Evaluation and Assessment Committee which consists of sub-recipients and clients that it is not feasible to add Non-Medical Case Management because it would create a barrier for the clients due to having to see multiple staff and make multiple appointments, which is something the clients and provider agreed would cause a barrier. The Evaluation Committee agreed that EIS workers could take some of those Non-Medical Case Management duties from the medical case managers which will give them more time to focus on the clients' helthcare outcomes. Final approval and acceptance of the corrective action taken is still pending. Upon final approval from the HRSA, this finding will be considered addressed and closed.

Categories

Allowable Costs / Cost Principles Internal Control / Segregation of Duties

Other Findings in this Audit

  • 962542 2023-005
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
21.023 Emergency Rental Assistance Program $53.74M
21.027 Coronavirus State and Local Fiscal Recovery Funds $29.32M
93.568 Low-Income Home Energy Assistance $16.77M
93.967 Cdc's Collaboration with Academia to Strengthen Public Health $8.74M
14.272 National Resilient Disaster Recovery Competition $8.49M
93.914 Hiv Emergency Relief Project Grants $8.15M
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $6.02M
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $4.32M
93.569 Community Services Block Grant $2.82M
93.268 Immunization Cooperative Agreements $2.72M
14.218 Community Development Block Grants/entitlement Grants $2.48M
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $2.06M
93.137 Community Programs to Improve Minority Health Grant Program $2.00M
93.940 Hiv Prevention Activities_health Department Based $1.91M
93.686 Ending the Hiv Epidemic: A Plan for America — Ryan White Hiv/aids Program Parts A and B (b) $1.89M
16.575 Crime Victim Assistance $1.74M
20.205 Highway Planning and Construction $1.70M
93.563 Child Support Enforcement $1.41M
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $1.41M
16.738 Edward Byrne Memorial Justice Assistance Grant Program $1.33M
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $1.29M
93.052 National Family Caregiver Support, Title Iii, Part E $1.21M
93.917 Hiv Care Formula Grants $1.08M
93.817 Hospital Preparedness Program (hpp) Ebola Preparedness and Response Activities $917,800
97.067 Homeland Security Grant Program $890,649
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $784,751
14.900 Lead-Based Paint Hazard Control in Privately-Owned Housing $741,887
93.074 Hospital Preparedness Program (hpp) and Public Health Emergency Preparedness (phep) Aligned Cooperative Agreements $672,490
93.136 Injury Prevention and Control Research and State and Community Based Programs $391,962
66.001 Air Pollution Control Program Support $389,332
93.994 Maternal and Child Health Services Block Grant to the States $387,274
14.231 Emergency Solutions Grant Program $323,023
93.086 Healthy Marriage Promotion and Responsible Fatherhood Grants $262,651
66.312 State Environmental Justice Cooperative Agreement Program $200,000
20.607 Alcohol Open Container Requirements $198,159
95.001 High Intensity Drug Trafficking Areas Program $195,167
93.053 Nutrition Services Incentive Program $191,980
93.041 Special Programs for the Aging_title Vii, Chapter 3_programs for Prevention of Elder Abuse, Neglect, and Exploitation $184,643
93.283 Centers for Disease Control and Prevention_investigations and Technical Assistance $176,156
81.086 Conservation Research and Development $175,230
14.239 Home Investment Partnerships Program $167,502
93.575 Child Care and Development Block Grant $161,432
97.042 Emergency Management Performance Grants $150,384
93.991 Preventive Health and Health Services Block Grant $147,340
16.017 Sexual Assault Services Formula Program $141,378
20.600 State and Community Highway Safety $138,773
66.034 Surveys, Studies, Research, Investigations, Demonstrations, and Special Purpose Activities Relating to the Clean Air Act $136,699
93.043 Special Programs for the Aging_title Iii, Part D_disease Prevention and Health Promotion Services $121,190
16.833 National Sexual Assault Kit Initiative $119,129
16.585 Drug Court Discretionary Grant Program $115,574
16.838 Comprehensive Opioid Abuse Site-Based Program $101,316
97.056 Port Security Grant Program $95,420
93.042 Special Programs for the Aging_title Vii, Chapter 2_long Term Care Ombudsman Services for Older Individuals $90,556
93.324 State Health Insurance Assistance Program $90,528
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $75,889
16.588 Violence Against Women Formula Grants $54,657
93.747 Elder Abuse Prevention Interventions Program $52,768
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $48,587
16.609 Project Safe Neighborhoods $42,931
20.614 National Highway Traffic Safety Administration (nhtsa) Discretionary Safety Grants $37,451
90.404 2018 Hava Election Security Grants $29,814
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $29,365
93.426 Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke $20,857
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $19,512
16.812 Second Chance Act Reentry Initiative $15,225
93.247 Advanced Nursing Education Grant Program $15,000
93.071 Medicare Enrollment Assistance Program $11,266
20.526 Buses and Bus Facilities Formula, Competitive, and Low Or No Emissions Programs $10,794
93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs $10,500
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $2,475