Finding 9107 (2023-001)

Finding 2023-001: Special Tests and Provisions - Sliding Fee Scale Documentation Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: COVID - 19 - Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), COVID - 19 - Grants for New and Expanded Services under the Health Center Program, Grants for New and Expanded Services under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 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 based on 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 necessary documentation to support the patient's income and family size in order to determine the sliding fee discount. Context A test of 40 sliding fee discount transactions was performed and resulted in two instances where the Center could not provide the necessary forms to support patient income and family size. Our sample was a statistically valid sample. Questioned Costs None. Cause The Center did not have adequate internal controls in place to effectively ensure that the proper sliding fee discount was calculated and applied based on the Center's sliding fee discount policy. Effect The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance. Wood River Health Services, Inc. Schedule of Findings and Questioned Costs Year Ended June 30, 2023 41 Identification of Repeat Finding Yes - See finding 2022-001 Recommendation The Center should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated based on patient provided forms. 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.