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Item: 2025-002 Assistance Listing Number: 93.224 Program: Health Center Program Federal Agency: U.S. Department of Health and Human Services Contract Number: 24H80CS28365; H8JCS54690; 21H8HCS44987 Award Year: June 1, 2024 to May 31, 2025; December 1, 2024 to November 30, 2025 September 1, 2023 to August 31, 2025 Compliance Requirement: Special Tests and Provisions Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: For five claims tested, the discount for eligible patients was inaccurately calculated and billed. Questioned Costs: N/A Context: In a population of 7,227 claims, we conducted a non-statistical sample of 40 claims. For five claims tested, we noted the discount for eligible patients was inaccurately calculated and billed. We also noted no evidence of management review or approval of the sliding fee discount applied. Effect: The system of internal controls was not properly implemented to ensure review and approval of the sliding fees discounts applied prior to billing the eligible patients. This is deemed to be a material weaknesses in internal control over compliance. Cause: The Organization does not have a supervisory review process implemented for application of the sliding fee discount. Identification as a Repeat Finding: Not a repeat finding. Recommendation: The Organization should implement additional controls to ensure claims where a sliding fee discount is applied are reviewed and approved prior to billing the patient. This review and approval should be clearly documented. Views of Responsible Officials: Management of the Organization concurs with the finding. See Corrective Action Plan.

Single Audit Reporting Package Not Submitted in a Timely Manner FAL#: All federal programs Questioned Costs: None 200.512 of the Uniform Guidance requires the the Organization submit an annual single audit reporting package and submit it data collection form prior to nine months after the end of the audit period. The Organization did not submit its single audit audit reporting package or data collection form within the required timeline. Staffing turnover. Due staffing turnover the Organization was not in compliance with provisions of 200.512 of the Uniform Guidance. The Organization should work to increase accounting staffing and focus on preparing supporting schedules for the preparation of its financial statements in a timely manner.

Special Tests and Provisions - Sliding Fee Scale Discounts Federal program: FAL 93.224 Health Center Program U.S. Department of Health and Human Services Federal grant number: H8HCS44987 Criteria: Patients applying for sliding fee scale (SFS) discounts should have their income levels adequately documented and accurately calculated, and patients should be given the proper discount based upon their income level in accordance with 42 CFR Section 51c.303(f). Condition: The Organization requires patients that apply for the SFS discount to complete attestation forms that includes their household sizes and income levels, and these forms are then used to determine patients' SFS discounts. One patient attestation form out of twenty-five SFS patient encounters that we tested was missing, and another SFS encounter that we tested did not have patient attestation form covering the date of service. Cause: Unknown Effect: Due to missing attestation forms, we could not determine whether the Organization consistently provided patients with the proper discount based upon their income levels. Recommendation: To help ensure that SFS discounts are properly calculated and documented, the Organization should perform random reviews of its SFS applications in order to detect and correct errors or incomplete applications on a timely basis.

Single Audit Reporting Package Not Submitted in a Timely Manner Federal program: FAL#: All federal programs Questioned Costs: None Criteria: 200.512 of the Uniform Guidance requires the the Organization submit an annual single audit reporting package and submit it data collection form prior to nine months after the end of the audit period. Condition: The Organization did not submit its single audit audit reporting package or data collection form within the required timeline. Cause: Staffing turnover. Effect: Due staffing turnover the Organization was not in compliance with provisions of 200.512 of the Uniform Guidance. Recommendation: The Organization should work to increase accounting staffing and focus on preparing supporting schedules for the preparation of its financial statements in a timely manner.