Finding Text
Item 2022-001 - Special Tests and Provisions on Sliding Fee Discounts: U.S. Department of Health and Human Services, Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) (Federal Assistance Listing Number 93.224); COVID-19 - Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) (Federal Assistance Listing Number 93.224) and Grants for New and Expanded Services Under the Health Center Program (Federal Assistance Listing Number 93.527). Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guidelines, as revised by HHS (42 CFR Sections 51c.107(b)(5), 56.108(b)(5) and 56.303(f)). Statement of condition: During our review of patient billing, one out of 25 samples selected for testing the internal control over compliance in relation to applying the Center's sliding fee scale had exceptions, specifically, the sliding fee scale used was not the scale in effect at the date of the visit. Cause: The new sliding fee scale was not completely and timely implemented for all types of visits. Effect: The Center did not comply consistently with the special tests and provisions compliance requirement on sliding fee discounts based on the poverty guidelines as such, the Center may not have properly calculated the sliding fee discount given to patients and the discount given, if any, may not have been based on the patient's ability to pay. Questioned costs: None. Context: For our test of control over compliance, one out of the 25 samples tested had an exception. Identification as a repeat finding: This is not a repeat finding. Recommendation: We recommend that the Center implement the sliding fee scale across all types of visits on a timely basis. We recommend that proper training be given to employees to ensure that they have the knowledge and skills to implement the sliding fee scale and to review the sliding fee discount given to patients.