Finding Text
Federal Agency: U.S. Department of Health and Human Services
Federal Program Title: Health Center Program Cluster
Assistance Listing Numbers: 93.224 and 93.527
Federal Award Identification Number and Year: H80CS00109-20; H80CS00109-21
Award Period: May 1, 2021 – April 30, 2022; May 1, 2022 – April 30, 2023
Type of Finding: Compliance and Material Weakness in Internal Control over Compliance
Criteria or specific requirement: 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 (discounted) based on the patient’s ability to pay. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)).
Condition: The Organization did not maintain documentation to show that patients had been evaluated for eligibility under its sliding fee scale policy and incorrectly calculated or applied the sliding fee scale policy based on their family size and annual income.
Questioned costs: None.
Context: This condition occurred in twenty-six (26) of forty (40) transactions selected for testing.
Cause: Unknown.
Effect: Patients may not be assessed are not charged according to the Organization's sliding fee scale and their ability to pay.
Repeat Finding: Yes, prior year finding 2021-005.
Recommendation: Management should refine and expand its internal audits of patient visits and hold additional trainings for front desk staff to ensure they understand the appropriate steps to take, and information to obtain, for sliding fee encounters.
Views of responsible officials: There is no disagreement with this finding.