Purpose

To minimize barriers as well as improve access to care for patients who meet certain sliding fee discount program eligibility criteria to ensure that the company provides services to all patients, using the Federal Poverty Level Guidelines to establish fair charges for services. No discounts will be given to patients above 200% of poverty level. No payment is required of homeless patients below 100% of poverty level.

Policy

No patient will be denied service simply due to their inability to pay for services. Patients will be expected to comply with the efforts of registration staff members to ascertain the existence of any third-party insurance coverage a patient may possess, or otherwise appropriately document said patient’s inability to pay for services. Patients eligible for sliding scale coverage will have the remainder of their charges incurred discounted as established by the GraceMed Health Clinic Board of Directors.

A patient’s eligibility for the sliding fee discount program is based on their ability to pay, which is determined by the patient’s income and family size as a percentage of the federal poverty guidelines. No other factors, including health insurance status, population type, or county of residence will be used to determine eligibility. For the purpose of this policy, GraceMed defines Income and Family Size as detailed below:

a.) Income – Gross annual income, before taxes and other deductions, of all family members from all sources, including but not limited to present and past employment, self-employment, government benefits, child support, court orders, and investment income
b.) Family size – Individuals of a household both traditional and non-traditional families that are tied together financially.

Based on proof of income presented and/or support verification recorded on such form, said patient will be informed of any eligibility for a sliding scale discount of services. Sliding scale discounts will be based on the most recent Federal poverty guidelines. Individuals and families with annual incomes above 200 percent of the FPG are not eligible for sliding fee discounts. Individuals and families with income at or below 100% of the FPG will be charged a “nominal fee” as established by the GraceMed Board of Directors. Patients without proper proof may either reschedule or pay $100 for the visit. Patients’ D.O.B. and current address are verified and documented during the eligibility process. Determination of eligibility for sliding scale discounts will be done on either a quarterly, semi-annual or annual basis, based on the proof of income provided. For patients whose income is not expected to change during the next 12 months eligibility will be completed on an annual basis.

The revenue cycle manager, clinic manager, or PSR lead may reduce or waive the sliding fees and/or nominal charges as well as extend the time period for self-attestation of family size and income under the following specific patient circumstances in order to minimize barriers and ensure access to care.

a. Homeless status of the patient, as defined in the HRSA/BPHC Program Assistance Letter 99-12, section II E, with no current income.
b. For purposes of maintaining privacy, confidentiality, and/or patient safety. Examples could include but not limited to domestic abuse.
c. Exceptional financial, physical, or emotional hardship that would preclude the patient from being able to pay the fee or nominal charge or supply family size and income documentation. Examples could include but not limited to natural/manmade disasters or crime victim.

Patients qualifying for a sliding scale discount will be expected to pay the discounted fee at the time services are rendered. This payment will cover the office visit only. This payment does not cover the cost of pharmaceuticals or lab charges. Charges for all services rendered are to be recognized at their full value within the practice management system, and fully discounted apart from the applicable fee.

Applicability

This policy applies to all patients seeking the sliding fee discount program from the company.