Finding 8095 (2023-001)

-
Requirement
M
Questioned Costs
-
Year
2023
Accepted
2024-01-10

AI Summary

  • Core Issue: The Alliance failed to provide essential subrecipient information and conduct required risk assessments, leading to non-compliance with federal guidelines.
  • Impacted Requirements: Key elements such as unique identity numbers, federal award details, and risk assessments were not communicated or documented as required by the Uniform Guidance.
  • Recommended Follow-Up: Implement training and templates for subaward communication, formalize risk assessment procedures, and establish clear monitoring protocols based on subrecipient risk levels.

Finding Text

2023-001 – Subrecipient Information and Monitoring Grantor: Centers for Disease Control and Prevention (CDC) Passthrough Agency: Massachusetts Department of Public Health Program Name: Massachusetts Community Health Worker for Resilience Award Name: Community Health Workers for Public Health Response and Resilient Award Year: Various Award Number: INTF4207M03225031012 Assistance Listing Number: 93.495 Criteria The Uniform Guidance states that: a pass-through entity (PTE) must • Identify the Award and Applicable Requirements including clearly identify information to the subrecipient. • Evaluate Risk – Evaluate each subrecipient’s risk of noncompliance for purposes of determining the appropriate subrecipient monitoring related to the subaward (2 CFR section 200.332(b)). • Monitor – Monitor the activities of the subrecipient as necessary to ensure that the subaward is used for authorized purposes, complies with the terms and conditions of the subaward, and achieves performance goals (2 CFR sections 200.332(d) through (f)). Condition Through our testing of the subrecipient information and monitoring at the Alliance over the Massachusetts Community Health Worker for Resilience program, we selected four organizations to whom the Alliance passed federal funding through to during fiscal year 2023. For each of the four selections, the entity was not able to evidence that they provided all required information to subrecipients at the time of the subaward (or subsequent subaward modification), as per the OMB compliance supplement requirements. Specifically, as per the review of the sub-award agreement, we were not able to verify the below information was communicated to the subrecipient at the time of the execution of the subaward agreement: i) Sub-recipient's Unique Identity Number ii) The entity's Federal Award Identification Number iii) Name of Federal awarding agency iv) Contact information for awarding officials of CHA v) Assistance Listing Number and Title vi) Indirect cost rate for the Federal award In addition, it was noted that documentation of a risk assessment being performed prior to entering into the subcontract was not available for the four selections and there was no formal documentation of subsequent subrecipient monitoring. There was also no evidence of review of uniform guidance reports. Cause The Alliance has policies in place for subrecipient monitoring that address the communication of award information to the subrecipient, risk assessments and continued monitoring but due to lack of training and understanding, those policies were not executed properly on this award. Effect There was a lack of communication to the subrecipient regarding the subaward agreement. The lack of formal documentation of initial risk does not allow the Alliance to ensure consistency in their risk assessments of subrecipients nor does it allow for a formal annual reassessment of risk and a clear linking of these assessments to the level of subsequent subrecipient monitoring. Questioned Costs None noted. Recommendation We recommend the Alliance implement training and a template to be utilized for the communication of the subaward information as well as an initial risk assessment and a continuing reassessment. In addition to these tools, we recommend the Alliance consider the following: • Formalize procedures to communicate the subaward information to the subrecipient • Implementing a formal review of the initial assessment prior to entering into the agreement as well as continuing subrecipient risk reassessments, including review of Uniform Guidance Reports • Formalizing the monitoring that is expected when a subrecipient is categorized as high versus low risk and the departments/individuals responsible for such monitoring • Formalize the annual subrecipient risk assessment process and the criteria to be reviewed and ensure it includes all subrecipients. Input into this assessment should be obtained from various constituents, including the Key Personnel. Management’s Views and Corrective Action Plan Management’s response is included in “Management’s Views and Corrective Action Plan” included at the end of this report after the summary schedule of status of prior audit findings.

Corrective Action Plan

Management’s Views and Corrective Action Plan 2023-001 – Subrecipient Information and Monitoring Grantor: Centers for Disease Control and Prevention (CDC) Passthrough Agency: Massachusetts Department of Public Health Program Name: Massachusetts Community Health Worker for Resilience Award Name: Community Health Workers for Public Health Response and Resilient Award Year: Various Award Number: INTF4207M03225031012 Assistance Listing Number: 93.495 The Alliance has implemented a template effective December 1, 2023 to be utilized for the communication of the subaward information as well as an initial risk assessment and a continuing reassessment template. Additionally, the Alliance will be developing formalized procedures to communicate with subrecipients. The Alliance will be using a checklist to formally review the initial and continuing agreements and will include high and low risk determinations. These will be implemented in February 2024 and be reviewed on an annual basis for any continued funding. Jill Batty Chief Financial Officer Cambridge Health Alliance 350 Main Street Malden, MA 02148

Categories

Subrecipient Monitoring

Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund $10.34M
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $3.72M
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $1.42M
93.495 Community Health Workers for Public Health Response and Resilient $1.36M
93.104 Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances (sed) $947,219
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $477,152
93.393 Cancer Cause and Prevention Research $452,149
93.217 Family Planning_services $445,000
93.191 Graduate Psychology Education Program and Patient Navigator and Chronic Disease Prevention Program $415,765
93.940 Hiv Prevention Activities_health Department Based $360,000
93.914 Hiv Emergency Relief Project Grants $347,551
93.859 Biomedical Research and Research Training $344,294
16.575 Crime Victim Assistance $295,017
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $247,991
93.959 Block Grants for Prevention and Treatment of Substance Abuse $237,164
93.788 Opioid Str $235,000
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $192,041
93.213 Research and Training in Complementary and Integrative Health $162,157
93.279 Drug Abuse and Addiction Research Programs $145,500
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $142,550
93.838 Lung Diseases Research $130,645
93.136 Injury Prevention and Control Research and State and Community Based Programs $120,696
97.044 Assistance to Firefighters Grant $111,560
93.153 Coordinated Services and Access to Research for Women, Infants, Children, and Youth $110,181
93.186 National Research Service Award in Primary Care Medicine $73,350
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $61,328
93.U01 Harnessing Electronic Health Records to Enhance Reporting to the Vaccine Adverse Event Reporting System (vaers) $52,117
14.218 Community Development Block Grants/entitlement Grants $44,892
93.236 Environmental Quality and Protection Resource Management $40,000
93.161 Health Program for Toxic Substances and Disease Registry $39,836
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation’s Health $39,631
93.732 Mental and Behavioral Health Education and Training Grants $39,235
93.307 Minority Health and Health Disparities Research $37,147
93.242 National Fire Plan - Rural Fire Assistance $24,902
93.273 Alcohol Research Programs $19,394
93.865 Child Health and Human Development Extramural Research $16,362
93.242 Mental Health Research Grants $12,514
93.226 Secondary and Two-Year Postsecondary Agriculture Education Challenge Grants $2,645
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $2,289