Finding Text
Health Center Program Cluster Assistance Listing Numbers 93.224 and 93.527 U.S. Department of Health and Human Services Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303 (f)) Condition ? Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization?s policy or not compliant with the Health Center Program Compliance Manual. Questioned cost ? None Context ? A sample of 25 patients were tested out of the total population of 68,391 encounters. The sampling methodology used is not and is not intended to be statistically valid. Three patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustment based on their income documentation. One patient received a sliding fee adjustment that is inconsistent to the Health Center Program Compliance Manual as the Organization?s policy was not in compliance with the Health Center Program Compliance Manual. Effect ? Sliding fee discounts were given to patients that were inconsistent with the Organization?s sliding fee discount policy. Cause ? The Organization did not comply with their sliding fee policy and a portion of the sliding fee policy was not in compliance with the Health Center Program Compliance Manual. Identification as a repeat finding, if applicable ? Is not a repeat finding. Recommendation ? We recommend management update their sliding fee policy to be in compliance with the Health Center Program Compliance Manual. Additionally, the Organization should continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy.