Finding Text
Finding 2023-001: Special Tests and Provisions
Grantor: U.S. Department of Health and Human Services
Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Center, 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 Grant 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 calculate the proper slide fee discount based on the respective patient family size and income or have adequate documentation on file to support the proper slide fee discount.
Context
A test of 40 sliding fee discount transactions was performed and resulted in an 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.
Questioned Costs
None.
Cause
The Center did not have adequate internal controls in place to effectively ensure that the proper slide fee discount was 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
Yes - 2022.001.
Recommendation
The Center should implement controls to ensure that all sliding fee discounts are properly calculated based on family size and income.
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.