Finding 610218 (2022-002)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-01-05
Audit: 34570
Organization: Hcc Network (MO)
Auditor: Forvis LLP

AI Summary

  • Core Issue: Patients received sliding fee discounts that did not align with the organization's established policy.
  • Impacted Requirements: Compliance with sliding fee discount criteria as outlined in federal regulations (42 USC 254(k)(3)(g) and 42 CFR sections 51c.303(g) and 56.303(f)).
  • Recommended Follow-Up: Ensure staff are trained on the sliding fee policy and implement procedures for accurate discount calculations; hire Financial Counselors for support.

Finding Text

Health Center Program Cluster Assistance Listing Numbers 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS26561, February 1, 2022-January 31, 2023 Award No. 6 H80CS26561, February 1, 2021-January 31, 2022 Award No. 1 H8FCS41198, April 1, 2021-March 31, 2023 Award No. 6 C14CS39928, September 1, 2020-August 31, 2023 Award No. 1 H8HCS44996, September 1, 2021-August 31, 2022 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. Questioned cost ? None Context ? A sample of 25 patients were tested out of the total population of 24,697 encounters. The sampling methodology used is not and is not intended to be statistically valid. Two patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documentation. 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. Identification as a repeat finding, if applicable ? Is not a repeat finding. Recommendation ? We recommend management continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Health Center Program Compliance Manual. Views of Responsible Officials and Planned Corrective Actions ? We are working on hiring Financial Counselors in each of the clinics to assist with slide fee calculations. We are also working on some internal spot checks to ensure that the slide fee calculations are correct. Organization contact persons responsible for corrective action: Lori Wyse, Outgoing Chief Financial Officer, Grants Manager Jonelle Hall, Chief Financial Officer Anticipated completion date: End of fiscal year 2023.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 33776 2022-002
    Significant Deficiency
  • 33777 2022-002
    Significant Deficiency
  • 33778 2022-002
    Significant Deficiency
  • 610219 2022-002
    Significant Deficiency
  • 610220 2022-002
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $2.13M
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $979,952
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $503,853
10.766 Community Facilities Loans and Grants $485,512
93.224 Covid-19 - Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $427,299
93.778 Medical Assistance Program $105,324
93.107 Area Health Education Centers Point of Service Maintenance and Enhancement Awards $93,908
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $46,268
93.800 Organized Approaches to Increase Colorectal Cancer Screening $25,911
93.137 Community Programs to Improve Minority Health Grant Program $6,680