PEAK VISTA COMMUNITY HEALTH CENTERS

Criteria or Specific Requirement – In accordance with the Health Resources & Services Administration Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program, health centers must prepare and apply a sliding fee discount schedule so that amounts owed for health care services by eligible patients are adjusted based on the patients’ ability to pay. In accordance with 42 CFR 56.303, health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient’s ability to pay. The patient’s ability to pay is determined based on the official poverty guidelines, as revised annually by U.S. Department of Health and Human Services (H…

Corrective action: Condition – Peak Vista (“the Organization”) determines the sliding fee discount charged to the patients based on their annual gross income and household size. During our testing of sliding fee discounts, we found that two encounters selected where the patients were charged incorrect copays. Recommendation – The Organization should strengthen processes surrounding the monitoring of the program to ensure the Organization’s policies are consistently and properly applied. Views of Responsible Officials and Planned Corrective Actions – Management agrees with the finding. The Organization has developed a plan for addressing this issue that includes updated procedures, training, and auditing. All t…

Criteria or Specific Requirement – In accordance with the Health Resources & Services Administration Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program, health centers must prepare and apply a sliding fee discount schedule so that amounts owed for health care services by eligible patients are adjusted based on the patients’ ability to pay. In accordance with 42 CFR 56.303, health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient’s ability to pay. The patient’s ability to pay is determined based on the official poverty guidelines, as revised annually by U.S. Department of Health and Human Services (H…

Corrective action: Condition – Peak Vista (“the Organization”) determines the sliding fee discount charged to patients based on the patient’s annual gross income and household size. We found two encounters where applications were not retained. Therefore, we could not determine if the sliding fee discount applied was in accordance with the guideline. Recommendation – We recommend that the Organization's procedures be strengthened to ensure income is properly verified and adequately documented and retained. The Organization should strengthen processes surrounding monitoring of the program to ensure the Organization’s policies are consistently and properly applied. Views of Responsible Officials and Planned Corre…

Criteria or Specific Requirement ? In accordance with the Health Resources & Services Administration Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program, health centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted based on the patients? ability to pay. In accordance with 42 CFR 56.303, health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient?s ability to pay. The patient?s ability to pay is determined based on the official poverty guidelines, as revised annually by U.S. Department of Health and Human Services …

Corrective action: Condition - Peak Vista determines the sliding fee discount charged to patients based on the patient's annual gross income and household size. We found two encounters where applications were not retained. Therefore, we could not determine if the sliding fee discount applied was in accordance with the guideline. We found two separate encounters where the patient did not meet the guidelines to receive a discount. We found one separate encounter where the patient was charged an incorrect co-pay. Recommendation - We recommend that Peak Vista's procedures be strengthened to ensure income is properly verified and adequately documented and retained. Peak Vista should strengthen processes surrounding…

Criteria or Specific Requirement ? Peak Vista is required to submit a Uniform Data System (UDS) Grant Report with the Health Resource and Service Administration (HRSA) with respect to the Health Center Program Cluster grants. Such report includes reporting certain line items such as Physician Clinic visits, Physician Virtual visits, NPs, PAs and CNMs Clinic visits and NPs, PAs and CNMs Virtual visits. Condition ? Peak Vista?s UDS Grant Report contained misstatements of visits for the year ended December 31, 2022. Context ? The remaining key line items as identified by the Office of Management and Budget (OMB) 2022 Compliance Supplement were accurately reported for the year ended December 31, 2022. Cause ? Peak Vista inadvertently misstated visits by type and provider. Effect or Potential Effect ? The visits reported to HRSA for the year were misstated. Questioned Costs ? There are no que…

Corrective action: Condition - Peak Vista is required to submit a Uniform Data System (UDS) Grant Report with the Health Resource and Service Administration (HRSA) with respect to the Health Center Program Cluster grants. Such report includes reporting certain line items such as Physician Clinic visits, Physician Virtual visits NPs, PAs and CNMs Clinic visits and NPs, PAs and CNMs Virtual visits. Recommendation - We recommend that Peak Vista's procedures be strengthened to ensure accurate reporting. Peak Vista should strengthen processes surrounding the review and reconciliation of supporting information used to complete the UDS Grant Report. Views of Responsible Officials and Planned Corrective Actions - Mana…

Criteria or Specific Requirement ? In accordance with the Health Resources & Services Administration Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program, health centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted based on the patients? ability to pay. In accordance with 42 CFR 56.303, health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient?s ability to pay. The patient?s ability to pay is determined based on the official poverty guidelines, as revised annually by U.S. Department of Health and Human Services …

Corrective action: Condition ? Peak Vista determines the sliding fee discount charged to the patients based on their annual gross income and household size. During our testing of sliding fee discounts, we found that five out of the 40 encounters selected were given a sliding fee discount, however a sliding fee application with gross income and household size was not retained. Sliding fee discounts provided to these five encounters totaled $845. There was a total of 53,259 encounters in the population. The sample procedures were not statistical. Recommendation ? We recommend that Peak Vista?s procedures be strengthened to ensure income is properly verified and adequately documented and retained. Peak Vista sho…