COMMUNITY MEDICAL CENTERS, INC.

Criteria: 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 (HHS). The schedule of di…

Corrective action: Name of Contact Person(s) Responsible for Corrective Action: Jaime Allen, Chief Financial Officer Training: Retrain staff on sliding fee policy procedures to ensure (1) income is properly verified, adequately documented and retained and (2) the sliding fee discount is properly determined and applied. All new Front Office staff will receive sliding fee program training as part of their 4-day front office training during onboarding. By Feb 28, 2022, the Front Office Trainer will review documentation requirements around sliding fee scale for patients, including checking applications for completion and making sure the sliding fee applied is being correctly calculated by all Front Office Leads, S…

Criteria: 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 (HHS). The schedule of di…

Corrective action: Condition Sliding Fee Discounts. Testing performed on the sliding fee discounts charged to patients based on annual gross income and household size, found sliding fee scales to be inappropriately unsupported. The result was patients were given an improper sliding fee discount without documentation to support that the patient qualified based on their income. In addition, one encounter was given a sliding fee discount tin an amount that did not match their annual gross income and household size resulting in an over charge to the patient. Lack of retaining forms and inaccuracy in the application of the sliding fee program discounts were due to inadequate oversight and review. Corrective actions…

Criteria: 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 (HHS). The schedule of di…

Corrective action: Community Medical Centers, Inc. Corrective Action Plan Year ended June 30, 2021 Finding Reference Finding 2021-001: Sliding Fee Discounts Condition 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 discount, we noted the following: Four (4) out of 25 encounters selected were given a sliding fee discount and no sliding fee application with gross income and household size was retained resulting in application of the sliding fee discount of $565.38. There was a total of 45,220 encounters and the sample procedures were not statistical. One (1) out of 25 encounters selected was giv…