Medical document

Sliding Fee Discount Program

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Policy

CHC/SEIA offers a sliding fee scale discount program to all patients with annual incomes at or below 200% of current DHHS Federal Poverty Guidelines. Board of Directors’ policy on the sliding fee scale discount program includes:

  • No aspect of the sliding fee scale discount program (SFD), including CHC/SEIA’s fees themselves, the procedures for assessing patient eligibility, or the procedures for collecting payments, is intended to create barriers to health care services. CHC/SEIA will review its SFD annually to determine if there are any aspects of the program that create a barrier to health care services.
  • All services within CHC/SEIA’s approved scope of project for which CHC/SEIA charges patients is offered on the SFD and is available to all patients regardless of their ability to pay.
  • CHC/SEIA will assure that patients are aware of the SFD by posting clear notices on waiting rooms, other prominent areas of the health center, website, and in correspondence with patients. All notices will be written in appropriate languages and literacy levels. All new patients will have the SFD program offered to them during the registration process.
  • Patients must bring required information for verification of family size and income at the time of their visit in order to qualify for the SFD. However, if the patient does not have the information, they have 30 days to provide the required information to check eligibility to receive a discount.
  • Income is defined as documentable income received through employment, government payments, retirement payments or cash received.
  • A household is defined as one or more individuals who are living together and sharing expenses and income.
  • CHC/SEIA may choose to establish separate Sliding Fee Discount schedules (SFD) based upon separate service types (e.g. dental/preventive, additional dental services, retail pharmacy contract services, lab testing, injectables, long acting birth control methods (ARCs), dentures).
    • The separate SFD schedules may have different nominal fees. Some non-required services will not have a sliding fee discount such as dental patients may be required to pay the entire amount of outside dental lab costs for dental restorative care devices (i.e., bridges, crowns, dentures, etc.) before the work is performed. This arrangement is generally done because other healthcare providers are willing to discount the regular charges if billed and paid by CHC/SEIA vs. what these providers would charge CHC/SEIA patients if the patient was billed directly.
  • the SFD will be adjusted annually to reflect any changes in DHHS Federal Poverty Guidelines, and this policy will be reviewed annually by the Board of Directors to determine if changes are needed to categories of the SFD, nominal fees or other policy and/or procedures.
  • CHC/SEIA shall maintain billing processes for patient services with health plans, including public health insurance (Medicare, Medicaid, CHIP and other public assistance programs) and private health insurance for patients who have such insurance, to ensure payer reimbursements are maximized.
  • CHC/SEIA will assure that fees are annually reviewed by the Board of Directors and established such that they cover reasonable costs and are consistent with locally prevailing rates or utilize charges for a cost/RVU rated development process for services. CHC/SEIA’s fee schedule will address all in-scope billable services and will be used as the basis for seeking payment from patients public and private health plans.
  • CHC/SEIA’s sliding fee scale program is established to ensure that uniform and reasonable fees and discounts are consistently and appropriately applied to qualifying health center patients.
  • For those patients that choose not to provide information required by CHC/SEIA to determine household size and income, even after being informed that they may qualify for discounts, will be viewed as declining eligibility for sliding fee scale discounts. CHC/SEIA will consider these patients to be ineligible for such discounts.
  • It is CHC/SEIA’s policy to establish a nominal fee for those patients eligible sliding fee scale category at 100% or below of poverty. It is not the health center’s intent to impede access to services due to an inability to pay the nominal fee. By applying a nominal fee, CHC/SEIA is trying to establish an appropriate means for patients to share in the cost of their care.
  • Patients with a health plan coverage are also eligible for the sliding fee scare discount program. If the health plan contracts with CHC/SEIA require the collection of certain amounts from patients (e.g. co-pay/co-insurance), CHC/SEIA will honor the contractual agreement. If CHC/SEIA is not contractually bound to collect the out of pocket costs, CHC/SEIA may charge patients on a sliding fee scale for actual out-of-pocket cost to the patient.
  • Patients will not be refused access to care due to an inability to pay. The CEO and CFO are able to waive the nominal fee or discounted price at their discretion based on the patient’s circumstances at the time of the waiver.
  • If CHC/SEIA is able to negotiate with an entity to subsidize or cover all or part of the fees for certain services for specific patients (e.g. national reference lab to donate their service for all CHC/SEIA patients that are uninsured). CHC/SEIA will utilize such sources to support discounts greater than those available through the health center’s sliding fee discount program (including those with a nominal fee) so long as it is in accordance with the terms and conditions of such entity.
  • CHC/SEIA will take reasonable action to encourage those other entities for which it has a fomral/informal written agreement for services (required/additional) to utilize CHC/SEIA slidin g fee discount program or similar discount/charges care programs for services provided for CHC/SEIA patients.

Procedures

  1. Poverty Guidelines: The most current DHHS poverty guidelines will be used in determining patient’s eligibility for the sliding fee scale program. These guidelines are published in the Federal Register annually.
  2. CHC/SEIA currently has five SFD levels (B – F).
    1. “B” – The patient’s family income is at 100% or below the current federal poverty income level. This is CHC/SEIA’s Nominal Fee level – fees based on type of service are listed on CHC/SEIA’s sliding fee schedules.
    2. “C” – The patient’s family income is greater than 100% but below 134% (101 – 133%) of the federal poverty income level. Fees based on type of service are listed on CHC/SEIA’s sliding fee schedule.
    3. “D” – The patient’s family income is greater than 133% but below 151% (134 – 150%) of the federal poverty income level. Fees based on type of service are listed on CHC/SEIA’s sliding fee schedule.
    4. “E” – The patient’s family income is greater than 150% but below 201% (151 – 200%) of the federal poverty income level. Fees based on type of service are listed on CHC/SEIA’s sliding fee schedule.
    5. “F” – The patient’s family income is greater than 200% of the federal poverty income level. Patients will be charged CHC/SEIA’s full charges. No sliding fee discount is available.
  3. CHC/SEIA has separate sliding fee discount schedules for medical, dental, pharmacy, lab, and injectables. Annually updated sliding fee schedules are approved by the board of directors and documented in the board minutes.
  4. How to apply: Patients are asked at the time of initial/annual re-registration to indicate on the Registration Form if they would like to apply for the sliding fee discount (or be re certified as eligible).
  5. Documentation Required: In order for an application to be reviewed, persons applying must provide appropriate documentation from the Acceptable Income Documentation List, which includes:
    • Check stub
    • W2 or W9
    • Social Security benefits
    • Retirement benefits
    • Disability benefits
    • Unemployment
    • Workers Compensation benefits
    • Veterans benefits
    • Child support
    • Welfare benefits (FIP; etc.)
    • Alimony/Widowers benefit
    • Student loans
    • Pensions
    • Military family allotments
    • Most recent tax return
  6. If a patient claims no income and is not employed and/or living with other persons, staff will determine if it is a “permanent” or “temporary” situation.
    • If the patient is temporarily living with someone and reports no income, they will be given the sliding fee discount for 90 days. The gross income and household size will be based only on the patient’s own gross income information that is reported. The patient must sign the No Income Verification Form. At the end of 90 days the patient will need to be re-evaluated if the no income status still applies.
    • If the patient is permanently living with someone (beyond 90 days), they will need to provide documentation of gross household income and household size. CHC/SEIA will bill the patient for his/her own charges.
  7. If the patient claims no income and is not living with anyone, then they need to sign the No Income Verification From and the patient will be given the sliding fee discount for 6 months. At the end of 6 months the patient’s income will need to be re-evaluated.
  8. Period of Eligibility: Once qualified, the individual will remain qualified unless a change in the household income or household size is reported that will change the sliding fee category or eligibility for the discount. Patients must be re-certified annually or at their next closest visit after their SFD anniversary date.
  9. Adjusting Patient Accounts: Once the application is approved, the patients account may be adjusted to reflect the SFD.