Finding Text
Finding 2022-001 ? Special Tests and Provisions ? Sliding Fee (repeat finding)Information on the federal program: U.S. Department of Health and Human Services CFDA No.93.224 and 93.527 Health Center Program ClusterCriteria: 42 CFR Section 51c.303(d) defines required project elements to include developing a soundcontrol system to ensure compliance with the regulations and terms and conditions of the grant. 42CFR Section 51c.303(f) establishes the requirement to have a schedule of fees or payments for theprovision of its services designed to cover its reasonable costs of operation and a correspondingschedule of discounts adjusted on the basis of the patient's ability to pay. Such schedule of discountsshall provide for a full discount to individuals and families with annual incomes at or below those setforth in the most recent CSA Poverty Income Guidelines and for no discount to individuals and familieswith annual incomes greater than twice those set forth in such Guidelines, except that nominal feesfor services may be collected from individuals with annual incomes at or below such levels whereimposition of such fees is consistent with project goals.Condition: We tested the controls over the application of the sliding scale fee discount for 40 patientvisits during the year. Out of the 40 tested, we noted 6 patients with one or more exceptions. Wenoted 5 instances in which the sliding fee discount was not properly applied and 5 instances in whichthe income documentation did not agree to the income amount used to determine the discount. Inaddition, we noted that documentation of review of the patient files was not properly documented.Cause: Eligibility documentation obtained by HSI for each patient is accumulated using an intakeform and income verification source documents. Per the Organization, the control system over thesliding fee program includes periodic review of patient files for accuracy and completeness. Thesefile reviews were not properly documented and therefore could not be verified as performed. For theexceptions noted by testing compliance, the income source documentation on file did not agree tothe income amount in the system used to determine the discount or the eligibility documentation wasnot properly evaluated and entered into the system. Therefore, the information used to apply thesliding fee discount was incorrect.Effect: Sliding fee discounts were not appropriately applied and patients were charged the incorrectamounts.Recommendation: We recommend the Organization strengthen its policies and proceduressurrounding the sliding fee scale to ensure compliance with the special tests and provisionrequirements.Views of Responsible Officials and Planned Corrective Action: See Management?s View andCorrective Action Plan included at the end of the report.