Finding 547358 (2024-005)

Significant Deficiency
Requirement
C
Questioned Costs
-
Year
2024
Accepted
2025-03-31

AI Summary

  • Core Issue: Delays in issuing checks after cash drawdowns for the Maternal and Child Health Services Block Grant, violating timely payment requirements.
  • Impacted Requirements: Non-compliance with 2 CFR 200.302 and 2 CFR 200.333 regarding cash management and record retention.
  • Recommended Follow-Up: Establish written procedures for prompt payments post-drawdown and monitor cash balances to address unused funds.

Finding Text

Finding Number: 2024-005 Agency: Department of Health & Human Services Federal Program: Maternal and Child Health Services Block Grant to the State ALN: 93.994 Grant Number: Various Compliance Requirement: Cash Management Category: Significant Deficiency in Internal Control over Compliance Criteria 2 CFR 200.302 states that each state must expend and account for the Federal award in accordance with state laws and procedures for expending and accounting for the state's own funds. 2 CFR 200.333 states that financial records, supporting documents, statistical records, and all other non-Federal entity records must be retained for a period of three years from the date of submission of the final expenditure report. For Federal awards that are renewed quarterly or annually, from the date of the submission of the quarterly or annual financial report, respectively, as reported to the Federal awarding agency or pass-through entity in the case of a subrecipient. Condition During our procedures, we found the following exceptions: a) In a sample of fifteen (25) cash drawdown petitions for Maternal and Child Health Services Block Grant to the State, we observed transactions with the check issued after the required time lapsed in accordance with the program advance type request. Cause Programs have not established written procedures and internal controls to properly follow up the finance division in order to pay to the suppliers and service providers on a timely basis. Effect Failure to minimize the time elapsed between the drawdown from the US Treasury to the actual check issue date may result in the calculation and determination by the Federal grantors of interest costs on the average balance of funds held beyond the reasonable time. This situation may also expose the PRDH to possible sanctions by federal grantors, such as withholding payments, or other special conditions. Questioned Costs None Perspective Information Finding represents a significant and repetitive problem. The Department will reinforce procedures over the disbursement process to ensure that all program payments are made within the 3 days timeframe. Prior Year Audit Finding None Recommendation The PRDH should establish written procedures that payments are issued promptly after the drawdown is made. This will minimize the time elapsed between the drawdown and the payment of funds. The PRDH should also establish a procedure to periodically monitor the cash balances of Federal programs for the possible identification, investigation, and resolution of unused funds. Views of responsible officials The PRDOH is working with the Finance Department to establish and strengthen our internal controls to ensure all payments comply with the guidelines established by the Federal Government. On the other hand, the PRDOH is working and verifying our own written procedures to ensure that payments are issued promptly after the drawdown is made. Responsible Officials Dr. Manuel Vargas Bernier Program Director 787-765-2929 ext. 4583 Mrs. Diana Ferrer Rivera Senior Accountant 787-765-2929 ext. 4551 Mrs. Lydia Magaly Cabrera Accountant 787-765-2929 ext. 4587 Estimated Completion Date The Completion date for the revised procedures will be by December 2025.

Corrective Action Plan

The PRDOH is working with the Finance Department to establish and strengthen our internal controls to ensure all payments comply with the guidelines established by the Federal Government. On the other hand, the PRDOH is working and verifying our own written procedures to ensure that payments are issued promptly after the drawdown is made.

Categories

Subrecipient Monitoring Cash Management Significant Deficiency Matching / Level of Effort / Earmarking

Other Findings in this Audit

  • 547353 2024-004
    Significant Deficiency
  • 547354 2024-004
    Significant Deficiency
  • 547355 2024-006
    Significant Deficiency
  • 547356 2024-006
    Significant Deficiency
  • 547357 2024-003
    Material Weakness Repeat
  • 547359 2024-007
    Material Weakness
  • 1123795 2024-004
    Significant Deficiency
  • 1123796 2024-004
    Significant Deficiency
  • 1123797 2024-006
    Significant Deficiency
  • 1123798 2024-006
    Significant Deficiency
  • 1123799 2024-003
    Material Weakness Repeat
  • 1123800 2024-005
    Significant Deficiency
  • 1123801 2024-007
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $2.88B
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $176.17M
93.767 Children's Health Insurance Program $77.96M
93.917 Hiv Care Formula Grants $28.44M
93.994 Maternal and Child Health Services Block Grant to the States $14.28M
93.268 Immunization Cooperative Agreements $6.89M
93.069 Public Health Emergency Preparedness $6.73M
93.940 Hiv Prevention Activities Health Department Based $6.26M
93.889 National Bioterrorism Hospital Preparedness Program $3.61M
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $3.12M
84.181 Special Education-Grants for Infants and Families $2.88M
93.255 Children's Hospitals Graduate Medical Education Payment Program $2.71M
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $2.62M
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $2.17M
93.991 Preventive Health and Health Services Block Grant $2.08M
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $1.91M
93.235 Title V State Sexual Risk Avoidance Education (title V State Srae) Program $1.31M
93.777 State Survey and Certification of Health Care Providers and Suppliers (title Xviii) Medicare $922,175
93.377 Prevention and Control of Chronic Disease and Associated Risk Factors in the U.s. Affiliated Pacific Islands, U.s. Virgin Islands, and P. R. $885,340
66.432 State Public Water System Supervision $785,668
66.468 Drinking Water State Revolving Fund $743,105
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $662,275
93.008 Medical Reserve Corps Small Grant Program $615,049
93.944 Human Immunodeficiency Virus (hiv)/acquired Immunodeficiency Virus Syndrome (aids) Surveillance $559,592
93.998 Autism and Other Developmental Disabilities, Surveillance, Research, and Prevention $486,151
93.092 Affordable Care Act (aca) Personal Responsibility Education Program $477,375
10.578 Wic Grants to States (wgs) $350,224
20.607 Alcohol Open Container Requirements $348,856
93.070 Environmental Public Health and Emergency Response $332,066
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $323,531
93.197 Childhood Lead Poisoning Prevention Projects, State and Local Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children $311,629
93.270 Viral Hepatitis Prevention and Control $304,885
93.251 Early Hearing Detection and Intervention $279,264
93.130 Cooperative Agreements to States/territories for the Coordination and Development of Primary Care Offices $239,207
93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs $234,342
93.870 Maternal, Infant and Early Childhood Home Visiting Grant $170,739
93.791 Money Follows the Person Rebalancing Demonstration $167,381
93.110 Maternal and Child Health Federal Consolidated Programs $121,289
93.314 Early Hearing Detection and Intervention Information System (ehdi-Is) Surveillance Program $121,114
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $84,934
93.387 National and State Tobacco Control Program $78,030
14.241 Housing Opportunities for Persons with Aids $64,329
93.048 Special Programs for the Aging, Title Iv, and Title Ii, Discretionary Projects $60,012
93.236 Grants to States to Support Oral Health Workforce Activities $55,547
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $52,483
93.334 The Healthy Brain Initiative: Technical Assistance to Implement Public Health Actions Related to Cognitive Health, Cognitive Impairment, and Caregiving at the State and Local Levels $25,684
93.336 Behavioral Risk Factor Surveillance System $5,903
93.945 Assistance Programs for Chronic Disease Prevention and Control $5,728
93.136 Injury Prevention and Control Research and State and Community Based Programs $5,300
93.497 Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports $0
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation’s Health $-5,882