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
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 slide 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.
Context
A test of 25 slide fee discount transactions was performed and resulted in one instance of a sliding
fee discount not being properly calculated based on the respective patient family size and income.
Our sample was a statistically valid sample.
Cause
The Center did not have adequate internal controls in place to effectively ensure that all sliding fee
discounts were properly calculated based on approved documentation.
Effect
The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance.
Identification of Repeat Finding
No.
Recommendation
The Center should establish a system of internal controls to ensure that all sliding fee discounts are
properly calculated based on family size and income.
Views of Responsible Officials
Management agrees with the audit finding and will strengthen internal controls and accountability to
correct the deficiency.