Sliding Fee Discount Program

In this section:

Primary Reviewer: Fiscal Expert

Secondary Reviewer: Governance/Administrative Expert

Authority: Section 330(k)(3)(G) of the Public Health Service (PHS) Act; 42 CFR 51c.303(f), 42 CFR 51c.303(g), 42 CFR 51c.303(u), 42 CFR 56.303(f), 42 CFR 56.303(g), and 42 CFR 56.303(u)

Health Center Program Compliance Manual Related Considerations

Document Checklist for Health Center Staff

Demonstrating Compliance

Select each element below for the corresponding text of the element, site visit team methodology, and site visit finding questions.

Footnotes

1. A health center’s SFDP consists of the schedule of discounts that is applied to the fee schedule and adjusts fees based on the patient’s ability to pay. A health center’s SFDP also includes the related policies and procedures for determining sliding fee eligibility and applying sliding fee discounts.

2. See [Health Center Program Compliance Manual] Chapter 4: Required and Additional Health Services for more information on requirements for services within the scope of the project.

3. A distinct fee is a fee for a specific service or set of services, which is typically billed for separately within the local health care market.

4. Income is defined as earnings over a given period of time used to support an individual/household unit based on a set of criteria of inclusions and exclusions. Income is distinguished from assets, as assets are a fixed economic resource while income is comprised of earnings.

5. Nominal charges are not “minimum fees,” “minimum charges,” or “co-pays.”

6. For example, a SFDS with discount pay classes of 101 percent to 125 percent of the FPG, 126 percent to 150 percent of the FPG, 151 percent to 175 percent of the FPG, 176 percent to 200 percent of the FPG, and over 200 percent of the FPG would have four discount pay classes between 101 percent and 200 percent of the FPG.

7. See [Health Center Program Compliance Manual] Chapter 16: Billing and Collections, if the health center has access to other grants or subsidies that support patient care.

8. For example, an insured patient receives a health center service for which the health center has established a fee of $80, per its fee schedule. Based on the patient’s insurance plan, the co-pay would be $60 for this service. The health center also has determined, through an assessment of income and family size, that the patient’s income is 150 percent of the FPG and thus qualifies for the health center’s SFDS. Under the SFDS, a patient with an income at 150 percent of the FPG would receive a 50 percent discount of the $80 fee, resulting in a charge of $40 for this service. Rather than the $60 co-pay, the health center would charge the patient no more than $40 out-of-pocket, consistent with its SFDS, as long as this is not precluded or prohibited by the applicable insurance contract.

9. Such limitations may be specified by applicable federal or state programs, or private payor contracts.

Date Last Reviewed: