University of Colorado Hospital Authority

93.914, Department of Health and Human Services, Health Resources and Services Administration, Ryan White Care Act Title I 5H89HA00027-2019 Pass-through Entity - City and County of Denver Finding Type - Significant deficiency Repeat Finding - Yes Criteria The grant agreement outlines specific eligibility determinations under common standards of care that the grant recipient must follow, including, but not limited to, maintaining evidence of a client's HIV status, geographic location, and income, and reassessing eligibility every six months. Condition Plante & Moran PLLC's testing of participant eligibility identified participants for which UCHA did not have proper documentation of all criteria considered while determining eligibility. Questioned Costs None. Identification of How Questioned Costs Were Computed N/A Context During fiscal year 2019, Plante & Moran PLLC selected 40 participants for eligibility testing. Of the 40, only 33 participants had proper documentation of all criteria considered to support the eligibility determination. Cause and Effect Plante & Moran PLLC reviewed files for 40 participants, of which 33 were found to contain all the required documentation of eligibility including residence, insurance, and other required measures. As a result, for the remaining 7 participants the required considerations to determine eligibility were not maintained. The lack of the documentation did not result in any ineligible individuals receiving service. Recommendation UCHA has designated a staff person responsible for collecting eligibility documentation. UCHA has a formal process for eligibility screening. The Denver Office of HIV Resources (DOHR), who administers the grant, has deemed UCHA's process to be a strong one. UCHA should continue to provide training on its process to ensure proper collection of eligibility documentation in accordance with DOHR's requirements. UCHA should maintain a checklist of each eligibility consideration for each participant and, for those participants unable to provide certain documentation, retain written consideration of why documentation was unable to be obtained. Views of Responsible Officials and Corrective Action Plan - UCHA has a specific improvement plan to continue addressing the participant eligibility standard audit finding. This standard has four reportable measures, which include maintaining evidence: (1) HIV verification support, (2) proof of income support, (3) proof of residency support, and (4) proof of insurance support. The two standards that are not at 100 percent include: proof of residency support and proof of income support. Clinic management will be required to maintain a checklist that indicates that the eligibility documentation was requested at the following intervals: patients? birthday and half birthday or upon arrival for a scheduled clinic visit. If the proof of residency and proof of income support is not provided to the clinic at these requested intervals, this will be documented on the checklist as ?patient was unable to provide residency and income support.? UCHA finance administration will monitor for continued improvement of the semiannual residence and eligibility verification process, which includes a twice annual internal audit to review no less than 40 patient records to test for standard compliance. Additionally, Finance administration will conduct monthly meetings with the UCH clinic manager and UCH clinic director to address staffing, training, and other concerns of the Ryan White verification process.

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