Maverick County Hospital District’s Ryan White HIV/AIDS Program slapped with deficiencies by Bexar County Auditor
By: Jose G. Landa, Copyright 2014, Eagle Pass Business Journal, Inc.
During the Maverick County Hospital District (MCHD) Board of Directors regular meeting held on Wednesday, April 30, 2014, at the Second Floor Conference Room at the MCHD Office in Eagle Pass, Ryan White HIV/AIDS Program Director and current Interim Chief Executive Officer, William Worrell, presented the MCHD Board the Bexar County Auditor’s Report of the 2012-2013 Fiscal Year of MCHD’s Ryan White HIV/AIDS Program showing seven (7) deficiencies slapped on the MCHD’s administration of the program from October 15, 2012 through August 31, 2013 grant period.
MCHD inherited the Ryan White HIV/AIDS Program from the United Medical Centers (UMC) in 2012 after also being signaled for serious problems at UMC and upon the request of George Kypuros, UMC Chief Executive Officer, to Elcira Bares, former MCHD CEO.
The Ryan White Program is for those persons who do not have sufficient health care coverage or financial resources for coping with the HIV disease. The Ryan White Program is the payor of last resort. The Ryan White Program “fills gaps in care not covered by other sources such as Medicare, Medicaid, or any major health insurance carrier, for those who have met the eligibility requirements. The majority of Ryan White Program HIV/AIDS Program funds support primary medical care and essential support services,” noted Susan T. Yeatts, CPA, Bexar County Auditor.
The MCHD Ryan White Program serves nine counties including Maverick, Uvalde, Val Verde, Real, Kinney, La Salle, Dimmit, Edwards, and Zavala.
The MCHD Ryan White Program was implemented on October 15, 2012 without formal MCHD Board of Directors approval; however, subsequent to Board member Ricardo E. Calderon raising a legal governance issue with the Board concerning the lack of the Board’s formal approval of the program, MCHD Legal Counsel Celeste Lira of Brin & Brin of San Antonio, Texas issued an opinion to the Board generally stating that Board approval was not required and the MCHD CEO had authority to enter into and implement the Ryan White Program. Shortly after Lira’s legal opinion, the MCHD Board nevertheless approved the Ryan White Program retroactively as a safety measure.
The Ryan White Program is a federal grant program that provides HIV/AIDS related health services and Bexar County is the recipient of said grant and the MCHD is a contractor serving as a sub-recipient service provider of the Ryan White Program. Bexar County administers the Ryan White Program through its Department of Community Resources (DCR).
The first deficiency slapped on the MCHD Ryan White Program’s administration was that “Requests for Reimbursements were not Submitted Timely,” said Bexar County Auditor Susan T. Yeatts, CPA. “MCHD submitted requests for reimbursements to DCR exceeding the contractual deadline; the submitted requests were incomplete, contained errors, or omitted information,” added Yeatts. “Additionally, MCHD responded untimely to DCR’s requests for additional documentation or corrections to process reimbursement requests, causing DCR to exceed to exceed the 21 day processing time,” said Yeatts.
The second deficiency signaled out was “Unexpended Funds.” “The Ryan White Program requires service providers to accomplish several mandatory criteria to continue operating as a service provider. One of the criteria is to utilize 95% of all funding to ensure maximum service coverage to all clients. Bexar County requires service providers, who cannot spend all of the funding provided, to submit a reallocation of funds request 60 business days prior, to the end of the project period,” said Yeatts. “Auditors noted MCHD had $21,868.33 in unutilized funds at the end of the project period, and it did not submit a request 60 business days prior, to the end of the project period to reallocate funds,” added Yeatts.
The third deficiency cited was “Program Income is not Computed, Collected, or Reported.” “The Ryan White Program has an income eligibility criterion, which is set below 300 percent of the federal poverty level for most service categories. The service provider contract,…all require service providers to seek fees (program income) from clients whose financial resources are between 100 and 300 percent of the federal poverty level to defray costs to further carry out the objectives of the grant programs. Additionally, the Texas Department of State Health Services (DSHS) requires all service providers to develop and implement a fee-for-service system, such as a sliding scale fee, for collecting program income,” said Yeatts, “The MCHD has not computed and collected program income and has not adopted or implemented either a system of sliding-fee schedules, as required by the Ryan White legislation, or through its own policy for the provision of discounted health care to low income or indigent individuals,” said Yeatts. “Auditors…noted that 27% of MCHD’s clients are between 100 and 200 percent of the federal poverty level, and 7% are between 200 and 300 percent. Therefore, MCHD should be collectinnng program income from its clients,” added Yeatts.
The fourth deficiency noted was “Memorandum of Understanding Agreements with Points-of-Entry were not found.” MCHD is contractually obligated by DSHS and DCR to establish Memorandums of Understanding (MOU) or agreement to ensure that formal relationships are established between funded service providers and entities that serve as points-of-entry into the continuum of care….During the course of the review, auditors noted that MCHD was not proactively seeking to develop a network of referral partnerships or agreements with other HIV/AIDS service providers, or with agencies at key points-of-entry to assist clients diagnosed with HIV/AIDS,” said Yeatts.
The fifth deficiency pinpointed was regarding the computer software “ARIES Data is incomplete and inaccurate.” The computer software “ARIES has three primary components to assist providers with achieving the Ryan White Grant objectives: Eligibility, Planning, and Treatment….Auditors tested a random sample of six client files containing a total of fourteen records. All client files contained errors…,” said Yeatts.
The sixth deficiency slapped was “A Separate Cost Center is not Maintained for the Ryan White Part B.” “A separate cost center is a unique series of general ledger accounts that categorizes expenses related to a specific cost objective, resulting in a separate revenue and expenditures statement that is grant specific. The Texas Department of State Health Services Contractor’s Financial Procedures Manual…states that MCHD must maintain a separate cost center for grant-related activity reporting. MCHD’s current accounting methodology does not record grant expenditures to the expense account related to a program cost category; instead it applies all grant expenditures, with the exception of salary and fringe benefits, to a miscellaneous general ledger account. As a result, the ledger account does not accurately describe or identify the nature of each grant expense, and it fails to produce a report that accurately reflects the grant program’s financial condition,” said Yeatts.
The seventh deficiency involves “Salary and Fringe Reimbursement Requests do not have Supporting Documentation.” “MCHD requested several reimbursements for direct salary, administrative salary, and fringe benefits based on budgeted percentages and cost allocation plans instead of actual time. Employees hours are allocated by the amount approved by the budget. The employee’s time does not reflect the actual hours worked in a cost category, but instead, uses a mathematival formula to spread out the time of the employee according to budgeted documents,” said Yeatts.
Worrell advised the MCHD Board that Chief Financial Officer Terri Contreras and Finance Assistant Nestor Bonilla and him had already submitted MCHD’s Management Action Plan to Bexar County in response to the seven (7) deficiencies slapped on the MCHD’s Ryan White Program by Bexar County Auditor Susan T. Yeatts, CPA.
The MCHD Board of Directors include Chairman Juan Manuel Farias, Vice-Chairman Rito J. Valdez, III, Secretary-Treasurer Humberto Duran, Joaquin L. Rodriguez, and Ricardo E. Calderon.
