Community Health Clinic, Inc.

Item 2021-001: Significant Deficiency in Internal Control Over Compliance for the Sliding Fee Scale Federal Program - Health Center Program Federal Agency - U.S. Department of Health and Human Services Pass-Through Entity - Not Applicable Assistance Listing Number - 93.224 Federal Award Year - December 31, 2021 Criteria: Section 330(k)(3)(G) of the Public Health Service Act requires that the Clinic must prepare and apply a sliding fee discount schedule that is based upon the most recent Federal Poverty Guidelines. Condition/Context: The Clinic did not update its sliding fee scale based upon the most recent Federal Poverty Guidelines for the year ending December 31, 2021 and used the same scale from the year ending December 31, 2020. Cause: The Clinic failed to follow its procedures for updating its sliding fee scale. Effect or Potential Effect: A patient at the clinic could have received the wrong discount based upon the sliding fee scale used. No patients were actually identified to have received the wrong discount. Questioned Costs: None noted. Recommendation: We recommend that the Clinic evaluate current review processes and controls for updating the sliding fee scale to use the most recent Federal Poverty Guidelines to ensure that the appropriate slide is processed. Views of Responsible Officials and Planned Corrective Actions: The Clinic agrees with the finding. Clinic management has reviewed the existing policy and have modified it. The Chief Financial Officer will now have to prepare the updated sliding fee schedule on an annual basis, and it will be reviewed and approved at first the monthly Finance Committee meeting and then next meeting of the Board of Directors.

Item 2020-001: Sliding Fee Scale Federal Program ? Health Center Program Federal Agency - U.S. Department of Health and Human Services Pass-Through Entity - Not Applicable Assistance Listing Number ? 93.224 Federal Award Year ? December 31, 2020 Criteria: Section 330(k)(3)(G) of the Public Health Service Act requires that the Clinic must prepare and apply a sliding fee discount schedule so that amounts owed for public health center services by eligible participants are adjusted (discounted) based on the patient?s ability to pay. Condition/Context: The application of the sliding fee discount schedule for 1 out of 40 patients tested was not appropriately applied based on the patient?s ability to pay. The sample was not a statistically valid sample. Cause: The Clinic failed to follow its procedures for applying the sliding fee discount schedule for this patient. Effect: The patient was billed the incorrect amount which was subsequently corrected. Questioned Costs: None noted. Recommendation: We recommend that the Clinic evaluate current review processes and controls for the application of the sliding fee discount to ensure that the appropriate slide is processed. This includes for all encounters covered under the period the slide is active. Views of Responsible Officials and Planned Corrective Actions: The Clinic agrees with the finding. Clinic employees have reviewed the Clinic?s policy and management will continue periodic training of front office staff on slide adjustment processing. In addition, the Clinic?s electronic medical records consultant will be asked to develop an exception report to identify patients with a slide on file who have not received sliding fee adjustments.