Finding Text
Finding 2023.001: Sliding Fee Scale Documentation
Grantor: U.S. Department of Health and Human Services
Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), COVID-19 Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), Grants for New and Expanded Services Under the Health Center Program, COVID-19 Grants for New and Expanded Services Under the Health Center Program
Federal Assistance Listing Numbers: 93.224 and 93.527
Compliance Requirement: Special Tests and Provisions
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 sliding fee discounts issued to patients in accordance with the Center's sliding fee scale.
Condition
The Center did not always have the proper slide fee documentation readily available to ensure the proper slide fee discount was applied based on approved policies.
Cause
The Center did not have adequate internal controls in place to effectively ensure that the proper sliding fee discounts were properly supported by approved documentation.
Effect
The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance.
Context
A test of 40 sliding fee discount transactions was performed and resulted in three instances where documentation was not readily available to ensure the proper slide fee discount was applied. Our sample was a statistically valid sample.
Questioned Costs
None.
Identification of Repeat Finding
Yes - 2022.001.
Recommendation
The Center should establish a system of controls to ensure that all sliding fee discounts are properly supported.
Views of Responsible Officials and Planned Corrective Actions
Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.