Finding 517646 (2024-001)

Finding 2024.001: Special test and provisions – Sliding Fee Discounts – Significant Deficiency Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster Community Health Centers Affordable Care Act (ACA) Grants for New and Expanded Services Under the Health Center Program COVID-19 Affordable Care Act (ACA) Grants for New and Expanded Services Under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H8000133 – 2024 and 2023, C14CS39925 - 2021, H8G48629 – 2023, H8L50678 – 2024, H8H46190 - 2023 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 approved policies or have adequate documentation on file. Cause The Center did not have adequate internal controls in place to effectively ensure that patients received the correct sliding fee discount and have adequate documentation on file. Effect The Center did not comply with the appropriate Special Tests and Provisions rules and regulations as per the Uniform Guidance in 2024. Questioned costs None. Context A test of 40 slide fee discount transactions was performed and resulted in seven instances of a sliding fee discount not being properly calculated based on the respective patient family size and income or inadequate documentation being on file. Our sample was a statistically valid sample. Identification of Repeat Finding Yes Recommendation The Center should establish a system of internal controls to ensure that all slide fee discounts are properly calculated and supported 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.