Tyler Family Circle of Care

Program Name/ALN Title: Health Center Cluster

Federal Assistance Listing Number: 93.224/93.527

Federal Agency: U.S. Department of Health and Human Services

Award Period: 6/1/2024 – 5/31/2025, 6/1/25-5/31/26

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. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)).

Condition: The organization assessed one patient with an incorrect sliding fee discount based on their family size and income documentation.

Context: One (1) of forty (40) transactions selected for testing. In the one instance, the organization collected less patient payments then they were entitled to.

Cause: Oversight.

Effect: Applicants assessed are not charged according to the Organization's sliding fee scale and their associated family size and income.

Recommendation: Management should consider increasing the frequency of its self-reviews of patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the collection and verification of patient information for each patient.

Views of the Responsible Officials: There is no disagreement with the audit finding.

Program Name/ALN Title: Health Center Cluster

Federal Assistance Listing Number: 93.224/93.527

Federal Agency: U.S. Department of Health and Human Services

Award Period: 6/1/2024 – 5/31/2025, 6/1/25-5/31/26

Criteria: 2 CFR 200.334 indicates that financial records, supporting documents, statistical records, and all other non-Federal entity records pertinent to a Federal award must be retained for a period of three years from the date of submission of the final expenditure report or, for Federal awards that are renewed quarterly or annually, from the date of the submission of the quarterly or annual financial report, respectively, as reported to the Federal awarding agency.

Condition: A variance was identified between the supporting documentation provided for the key line item in Table 8A, Line 17, Column C and what was reported in the final UDS report. Additionally, documentation was not available to support the amounts reported on Lines 8, Columns b and b2 and Line 10a, Columns b and b2 within Table 5.

Context: Three (3) of seven (7) key line items tested. These key line items are reported in Tables 5 and 8A.

Cause: Subsequent to the organization submitting its UDS report, it was requested to make a change by the initial UDS reviewer. The organization made the requested change but did not maintain documentation to support the adjusted amounts. For Table 5 the organization initially created a pivot table based on the underlying data but did not retaining this documentation and therefore couldn’t support the amounts reported.

Effect: Potential for inaccurate UDS report to be filed.

Recommendation: We recommend the organization enhances its current process related to the preparation of the UDS report and reinforce the requirement to maintain documentation to support the amounts reported within the various tables of the UDS report.

Views of the Responsible Officials: There is no disagreement with the audit finding.

Under the compliance requirement for Special Tests and Provisions for ALN 93.224/93.527, “health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay”. In three identified instances the sliding fee discounts applied were incorrect.

: Per 2 CFR 200.302, the state's and the other non-Federal entity's financial management systems, including records documenting compliance with Federal statutes, regulations, and the terms and conditions of the Federal award, must be sufficient to permit the preparation of reports required by general and program-specific terms and conditions; and the tracing of funds to a level of expenditures adequate to establish that such funds have been used according to the Federal statutes, regulations, and the terms and conditions of the Federal award. Further, the financial management system of each non-Federal entity must provide accurate, current, and complete disclosure of the financial results of each Federal award or program in accordance with the reporting requirements. According to §200.303 Internal controls of 2 CFR Part 200, the non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award.