Ozarks Resource Group D/B/A Ozarks Community Health CenterNon-Profit

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 Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale. Condition The Organization did not always appropriately apply the sliding fee discount based on income levels. Context A test of 40 discount transactions was performed and resulted in 5 instances where the Organization was unable to provide approved documentation. Our sample was a statistically valid sample. Questioned Costs None. Cause The Organization did not have adequate internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification of Repeat Finding No. Recommendation The Organization should ensure that internal controls are in place to effectively ensure that patients receive the correct sliding fee discounts. 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.

Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing No. 93.498 U.S. Department of Health and Human Services Criteria or Specific Requirement ? Reporting (45 CFR 75.342) and Activities Allowed or Unallowed and Allowable Costs/Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623). Condition ? The Organization is required to report on the use of Provider Relief Fund (PRF) distributions received. This report is to be prepared using accurate financial information following the accrual basis of accounting and other guidance issued by the U.S. Department of Health and Human Services (HHS). Questioned Costs ? Unknown Context ? The Period 1 PRF report was tested. The Organization utilized PRF distributions received on lost revenues incurred through June 30, 2021, calculated using Option iii. Certain adjustments impacting patient service revenue, including the estimated settlements for the 2021 Medicare and Medicaid cost reports were omitted from the lost revenue calculation. Effect ? Errors were made in calculating quarterly revenue from patient care used in lost revenue reporting. Cause ? The Organization did not include certain patient service revenue components when completing their lost revenue calculation. Identification as a Repeat Finding ? Not a repeat finding. Recommendation ? Policies and procedures over federal grant reporting should be monitored to ensure reports are prepared using complete and accurate information. Views of Responsible Officials and Planned Corrective Actions ? Planned Corrective Actions: OCHC has evaluated its lost revenue calculation used in the Period 1 Provider Relief Fund reporting and has determined that the lost revenue reported was not overstated. OCHC further identified that if the revenue amounts noted in finding 2022-001 had been included, the health center would likely have been able to report a higher amount of lost revenue. The health center has already repaid the Provider Relief Funds received in excess of the lost revenue amount previously reported and does not intend to make any additional changes to its Period 1 report. Responsible Official: Lindsay Pearson, CFO and Scott Crouch, CEO Anticipated Completion Date: March 31, 2023 Heather Center Response: The Health Center CEO, Scott Crouch and CFO, Lindsay Pearson discussed the planned corrective actions. They both feel comfortable with the amount of lost revenue reported. While the Health Center could have claimed additional lost revenue, by including the cost report amounts, at the time of the Provider Relief Fund reporting deadline, the cost reports for FY21, were not finalized. The Health Center used a more conservative approach in their lost revenue calculation, to avoid overstating this amount.