Recurring Findings

Emergency Medical Services: Recurring Most severe Noncompliance
Federal Program Issue First Year Reported
Department's Assertion Page Number
Preventive Health and Health Services Block Grant funded solely with Prevention and Public Health Funds Subrecipient Monitoring. Public Health and EMSA did not evaluate each subrecipient's risk of noncompliance with federal statutes, regulations, and the terms and condition of the subaward of the Public Health Emergency Preparedness, Immunization Cooperative Agreements, Preventive Health and Health Services Block Grant (PHHSBG), and National Bioterrorism Hospital Preparedness Programs. Public Health and EMSA did not have policies and procedures for evaluating each subrecipient's risk of noncompliance with federal statutes, regulations, and terms and conditions of the subaward in a timely manner. 2015-16
Partially Corrected. Each subrecipient has been given a risk assessment and score for state fiscal year 2016-17, which predicts their level of grant compliance for the fiscal year 2017-18 grant year. The risk assessment matrix and grant compliance criteria is reviewed annually and updated as necessary. Annually, each subrecipient will have their risk assessment evaluated and scored. In January 2017, Public Health/Chronic Disease Control Branch (CDCB) reviewed all federal statutes, regulations, and the terms and conditions of the federal PHHSBG award to determine whether or not policies and procedures existed and were operating effectively to ensure compliance with all requirements. In February 2017, Public Health/CDCB developed policies and procedures to evaluate each subrecipient’s risk of noncompliance with federal statutes, regulations, and the terms and conditions of the sub-award. On February 15, 2017, Public Health/CDCB hosted a PHHSBG Program Updates Meeting and shared the new processes and requirements with Public Health and EMSA PHHSBG programs. On February 24, 2017, Public Health/CDCB shared a Memorandum of Understanding (MOU) containing the requirements and restrictions with PHHSBG Programs and requested it be signed. The signed MOUs are retained in Public Health/CDCB’s files. On July 14, 2017, Public Health/CDCB hosted a PHHSBG orientation to share updated information pertaining to the requirements and restrictions, and to answer programs’ questions. On August 4, 2017, Public Health/CDCB distributed written guidance on the new processes and requirements, including evaluating subrecipient’s risk of noncompliance. Since November 2017, EMSA has been utilizing the Public Health Risk Assessment Tool for evaluating each subrecipient’s risk of noncompliance with federal statutes, regulations and the terms and conditions of the subaward. Public Health is currently working to centralize and streamline the subrecipient monitoring process. PHHSBG subrecipients will be monitored according to the assessed risk. Effective July 2017, the Immunization Branch implemented the use of a Request For Application (RFA) to ensure all potential subrecipients of federal funding were provided with federal grant information, compliance requirements, and terms and conditions in advance of submitting an application for funding. The RFA includes an acknowledgement form, which confirms the applicant has received and reviewed the information. Public Health is continuing to work on developing a tool to assess each subrecipient’s risk of noncompliance with federal statutes, regulations, and the terms and conditions of the federal award, as well as monitor subrecipients around the same items. Public Health has been researching appropriate items to include in the submonitoring checklist. The Immunization Branch is collaborating with both the state and Centers for Disease Control and Prevention (CDC) to determine what best practices exist to help in the development of the form. Public Health anticipates that a draft of the form will be completed by the end of August 2017 and then will solicit feedback from the state and CDC in the month of September 2017 in order to complete the form by October 2017. Emergency Preparedness Office (EPO) in collaboration with Grant Compliance Unit, part of the Office of Compliance, performed its risk assessment for noncompliance with federal statutes, regulations, and the terms and conditions of the federal award for all of its subrecipients. 56
Preventive Health and Health Services Block Grant funded solely with Prevention and Public Health Funds Subrecipient Monitoring. The Immunization Branch and Chronic Disease Control Branch (CDCB) of Public Health and EMSA did not communicate the universal identifier and system for award management requirements to applicants in accordance with 2 CFR 25.200. Additionally, the unique entity identifier was not collected prior to awarding funds in accordance with 2 CFR 25.205. Public Health and ESMA did not communicate to its subrecipients the required federal award data elements upon making a subaward, including identifying the award as a subaward in accordance with 2 CFR 200.331. Public Health and EMSA were not aware of these pre-award and post-award requirements for pass-through entities, and had not established a process to ensure required information is communicated to subrecipients. 2015-16
Partially Corrected. Public Health/CDCB and EMSA agree with this finding. In February 2017, Public Health/CDCB created policies and procedures to ensure the required information is communicated to applicants in accordance with 2 CFR 25.200, and that the unique entity identifier is collected prior to making subawards in accordance with 2 CFR 25.205. On February 15, 2017, Public Health/CDCB hosted a Program Updates Meeting and shared the new processes and requirements with Public Health and EMSA’s Preventive Health and Health Services Block Grant (PHHSBG) Programs. On February 24, 2017, Public Health/CDCB shared with programs a Memorandum of Understanding (MOU) containing the requirement to comply with 2 CFR 25.205 and requested it be signed. The signed MOUs are retained in Public Health/CDCB’s files. On July 14, 2017, Public Health/CDCB hosted an orientation to share updated information including the requirement to comply with 2 CFR 25.205. On August 4, 2017, Public Health/CDCB distributed written guidance on this requirement. CDCB plans to work with the Public Health Contract Management Unit to develop a PHHSBG specific contract checklist that will be required for all PHHSBG contracts. These requirements will be included in the PHHSBG Checklist. Public Health/CDCB will implement all aspects of this corrective action and maintain records demonstrating that such communications occurred. EMSA’s administrative staff met during May 2017 to discuss the audit findings and reviewed existing processes. The review process was completed before December 31, 2017. EMSA received in November 2017 the Public Health “Program Instructions for Potential PHHSBG Contractors and Sub Recipients Checklist” which was distributed to all PHHSBG programs. EMSA is utilizing this document to ensure that EMSA communicates to applicants in accordance with 2 CFR 25.200 and that the unique entity identifier is collected prior to making sub awards in accordance with 2 CFR 25.205. Additionally, this document also provides for the timely and proper communication of all applicable subaward information in accordance with 2 CFR 200.331 and ensures that EMSA maintain records demonstrating that such communications occurred. Effective July 2017, the Immunization Branch implemented the use of a Request For Application (RFA) to ensure all potential subrecipients of federal funding were provided with federal grant information, compliance requirements, and terms and conditions in advance of submitting an application for funding. The RFA includes an acknowledgement form, which confirms the applicant has received and reviewed the information. The universal identifier of each applicant is one data element collected through the RFA while the cover letter to the RFA identifies potential awards as subawards and provides required federal award information. 52