PRAIRIESTAR HEALTH CENTER, INC.Non-Profit

Health Center Program Cluster CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS08239-14-01 Program Year 2023 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 received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy. Questioned Cost – None Context – A sample of 40 patient encounters was tested out of the population of 76,396 encounters. The sample is not, and is not intended to be, statistically valid. Of the 40 patient encounters tested, 2 were determined to have resulted in an improper sliding fee adjustment based on the Organization’s policy and screening of patient eligibility. Effect – Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee policy. Cause – The Organization did not comply with their sliding fee policy. Identification as a Repeat Finding – Yes. Finding 2022-002. Recommendation – Management should ensure that sliding fee adjustments are properly applied in accordance with the sliding fee policy and patient eligibility.

Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing Number 93.498 U.S. Department of Health and Human Services Criteria or Specific Requirement ? Reporting (45 CFR 75.342) and Activities Allowed/Unallowed and 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 prepare and submit period-two Provider Relief Fund (PRF) reporting. This report is to be prepared using accurate financial information and submitted by the deadline established. Questioned Costs ? $101,859 ? calculated as the expenditures included on the PRF report for capital projects not completed by the end of the period of performance. Context ? The period two PRF report was tested. The Organization obligated the period two PRF funds received utilizing expenditures incurred to prevent, prepare for, and respond to coronavirus. In addition, the period two report also reflected lost revenues based on an alternative reasonable methodology. Effect ? The Organization applied expenditures to period two that did not meet the definition of a qualifying expenditure. Also, errors were made in reporting quarterly lost revenues. Cause ? The Organization charged a portion of provider relief funds for a capital facilities project. However, the Organization was unable to support that the capital project was completed before December 31, 2021, the end of the period of availability for period two PRF funds. In addition, the Organization did not identify certain patient service revenue adjustments to be included in the lost revenue calculation. Identification as a Repeat Finding ? Not a repeat finding. Recommendation ? Policies and procedures over the program should be monitored to ensure reporting is prepared using complete and accurate information and to ensure that allowable costs are charged in the correct period of performance. Views of Responsible Officials and Planned Corrective Actions ? During the 2022 audit of PrairieStar Health Center, Inc. our auditors found two instances of the PRF calculation being calculated incorrectly. The two instances were 1) having miscellaneous revenue adjustments in the actual calculation but not in the budget section of the lost revenue calculation and 2) not being able to directly identify if the capital project was completed before the period of availability for period two which is December 31, 2021. This has resulted in a finding in the current year financial statements audit. Management has evaluated the finding and reviewed whether any funds need to be repaid and evaluated its controls around future provider relief reporting cycles. It has been determined that even with the two errors identified lost revenues would have been sufficient to obligate the entire award. Therefore, we have determined no repayment is necessary. If allowed in future provider relief reporting periods, PrairieStar will correct the misreporting. In addition, management will ensure adequate time to review the provider relief reporting prior to the submission deadline in order to catch these oversights. Shandi Stallman, Chief Financial Officer, is the party that has overall responsibility for this corrective action. The anticipated completion date is expected to be March 2023.

Health Center Program Cluster CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS08239-14-01 Program Year 2020 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 received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization?s policy. Questioned Cost ? None Context ? A sample of 25 patient encounters was tested out of the population of 76,129 adjustments. The sample is not, and is not intended to be, statistically valid. Of the 25 patient encounters tested, 4 were determined to have resulted in an improper sliding fee adjustment based on the Organization?s policy and screening of patient eligibility. Effect ? Sliding fee discounts were given to patients that were inconsistent with the Organization?s sliding fee policy. Cause ? The Organization did not comply with their sliding fee policy. Identification as a Repeat Finding ? Not a repeat finding. Recommendation ? 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. Views of Responsible Officials and Planned Corrective Actions ?During the 2022 audit of PrairieStar Health Center, Inc. FORVIS found multiple instances of the sliding fee being either set up incorrectly or calculated incorrectly. Plan to Correct Finding Multiple steps will be taken to correct this finding. ? Meet with coding and billing staff to determine how to communicate when changes are made to the account after the sliding fee pulls in. There were several instances of the number of units being changed after the slide had applied to the account that were not communicated to the billing staff so that they could change the slide to the appropriate amount. ? Increased training of staff. This will be two pronged: 1) training for staff on calculating sliding fee eligibility and setting up the slide and 2) training for staff on making adjustments to sliding fees on a patient?s account. ? Increased review of slide setup, eligibility calculations, etc., to confirm compliance. Date of Completion Within the next month, we will hold a meeting with the billing and coding staff to determine the best way to communicate changes to accounts that have the sliding fee applied before units are changed. There is no completion date for the training and review. These will become routine, ongoing functions of the department. Responsible Party Shandi Stallman, Chief Financial Officer, is the party that has overall responsibility for this corrective action. In addition, the Business Office Managers for Medical, Dental, and Vision will play a key part in training and review.

Health Center Program Cluster CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS08239-14-01 Program Year 2020 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 received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization?s policy. Questioned cost ? None Context ? A sample of 25 patient encounters were tested out of the population of 29,631 adjustments. The sample is not, and is not intended to be, statistically valid. Of the 25 patient encounters tested, 5 were determined to have resulted in an improper sliding fee adjustment based on the Organization?s policy and screening of patient eligibility. Effect ? Sliding fee discounts were given to patients that were inconsistent with the Organization?s sliding fee policy. Cause ? The Organization did not comply with their sliding fee policy. Identification as a repeat finding ? Not a repeat finding. Recommendation ? 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. Views of Responsible Officials and Planned Corrective Action ? Management and all personnel involved will increase their training and review procedures for the sliding fee discount program in order to be in compliance with Uniform Guidance. Management and all personnel involved will make updates to the sliding fee scales to include all slide eligible procedures. The Chief Financial Officer and Business Office Managers are responsible for this corrective action plan.