Asian American Health Coalition of the Greater Houston Area d/b/a HOPE ClinicNon-Profit

2019-001 Health Center Program Cluster CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS24153-08-08 Program Year 2019 Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g) and 42 CFR section 56.303(f)). Condition ? Patients who were eligible for sliding fee discounts under the Organization?s policy were given incorrect sliding fee discounts, were not given sliding fee discounts for eligible visits or lacked documentation on sliding fee discount eligibility under the Organization?s policy. Questioned cost ? None Context ? A sample of 40 patient encounters were tested out of the population of 26,754 sliding fee discount transactions. The sample was not, and is not intended to be, statistically valid. Of the 40 patient encounters tested, 10 were determined to have resulted in an improper sliding fee adjustment based on the Organization?s policy and screening of patient eligibility. Effect ? Patients eligible for sliding fee discounts were not given discounts or were given improper sliding fee discounts. Cause ? The Organization did not comply with their sliding fee policy. Identification as a repeat finding ? Yes, 2018-001. Recommendation ? Management should review the existing sliding fee discount policy to ensure it is consistent with the intended function, while also maintaining compliance with the Health Center Program Compliance Manual if any changes are made. All personnel involved in the sliding fee discount program should demonstrate their understanding of the sliding fee scale policy in order to improve application of the sliding fee discount program. Additionally, the Organization should work to apply the sliding fee discount transaction code to only those transactions that are subject to its sliding fee discount program.

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