Finding 395631 (2023-001)

Federal Assistance Listing Finding 2023-001: Special Tests and Provisions Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Center, Health Care for the Homeless, and Public Housing Primary Care), COVID-19 Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), Grants for New and Expanded Services Under the Health Center Program, COVID-19 Grant Grants for New and Expanded Services Under the Health Center Program. Federal Assistance Listing Numbers: 93.224 and 93.527 Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5),56.108(b)(5) and 56.303(f)).The Center should be implementing and monitoring procedures to properly determine, calculate and review slide fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition The Center did not always calculate the proper slide fee discount based on the respective patient family size and income or have adequate documentation on file to support the proper slide fee discount. Cause The Center did not have adequate internal controls in place to effectively ensure that all sliding fee discounts were properly calculated based on approved documentation. Effect The Center did not comply with the appropriate Special Tests and Provisions rules and regulations as per the Uniform Guidance in fiscal year 2023. Questioned Costs None. Context A test of 40 discount transactions was performed and resulted in six instances of sliding fee discounts not being properly calculated based on the respective patient family size and income or inadequate document was on file to support the proper slide fee discount. Our sample was a statistically valid sample. Identification of Repeat Finding Repeat finding of 2022-001. Recommendation The Center should establish a system of internal controls to ensure that all sliding fee discounts are properly supported and calculated based on family size and income. Views of Responsible Officials Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.