CHASE BREXTON HEALTH SERVICES INC.

Criteria: Under this selected program, eligible individuals receive a sliding fee discount on amounts owed for health center services based on family size and income levels in comparison to the federal poverty guidelines. The Organization should maintain records providing evidence that the patients included under this program are eligible. Condition: During the compliance testing of 43 sample items, there were two instances where the patients had properly submitted their forms, but the Organization applied the incorrect sliding fee category. Effect: Currently, there is no known monetary impact, improper expenditure of funds or questioned costs identified. However, if the Organization does not strengthen the internal controls in regard to the eligibility determination process, there is a possible effect on the ability of the Organization to obtain additional funding under this program i…

Corrective action: Identifying Number: 2025-001 - Eligibility Finding: Under the Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) and Grants for New and Expanded Services Under the Health Center Program, eligible individuals receive a sliding fee discount on amounts owed for health center services based on family size and income levels in comparison to the federal poverty guidelines. The Organization should maintain records providing evidence that the patients included under this program are eligible. However, during the compliance testing of 43 sample items, there were two instances where the patients had properly submitted…

Criteria: Under this selected program, eligible individuals receive a sliding fee discount on amounts owed for health center services based on family size and income levels in comparison to the federal poverty guidelines. The Organization should maintain records providing evidence that the patients included under this program are eligible. Condition: During the compliance testing of 40 sample items, there was one instance where the Organization applied a sliding fee discount to a patient who had not submitted any documents regarding their income level or family size and should not have been included as a sliding fee patient, and two instances where the patients had properly submitted their forms, but the Organization applied the incorrect sliding fee rate. Effect: Currently, there is no known monetary impact, improper expenditure of funds or questioned costs identified. However, if th…

Corrective action: The Operations and Social Work and Outreach teams, under the leadership of Alice Sliwka, Chief Operating and Quality Officer, will review and revise our current practices to ensure education and accompanying audits address compliance for all Chase Brexton patients qualifying for a sliding fee discount. This will ensure that all persons, regardless of need, will be evaluated annually to ensure all required documentation is obtained, retained, and properly evaluated as to level of sliding fee scale. Chase Brexton will begin the process of evaluating and developing these protocols immediately with completion expected by March 31, 2025.

Criteria: Under this selected program, eligible individuals are those with low-income and those with HIV or, in certain circumstances, families of people with HIV. To the maximum extent practicable, services are to be provided to eligible individuals regardless of their ability to pay for the services and their current or past health condition (42 USC 300ff-15(a)(7)(A)). The Organization should maintain records providing evidence that the patients included under this program are eligible. Condition: During the compliance testing of 40 sample items, there were 9 instances where the Organization did not obtain and retain the patient’s proof of income to support eligibility under the program, and other cases where the information was obtained, but there was no evidence that anyone had reviewed the supporting documentation. However, there were no instances of lack of support for the require…

Corrective action: The operations team, under the guidance of Chief Operating and Quality Officer, will evaluate and develop a sustainable annual review process for all Chase Brexton patients qualifying for Ryan White services. This will ensure that all persons regardless of need will be evaluated annually or documented that they no longer quality for services under the Ryan White Part A program. Chase Brexton will begin the process of evaluating and developing these protocols immediately.