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Sliding Fee Discount Schedule Program

Federal Poverty Guidelines (FPG)

Patient Perspective

The nominal charge is assessed for fairness based on input of the patient by:

  • UHP's Schedule of Discounts reflect the current FPG
  • There are 4 discount pay classes between 100%-200% of the FPG
  • No discount will be given to patients above 200% of the FPG
  • UHP has elected to have a nominal charge for individuals/families below 100% of the FPG
  • Nominal charge does not reflect true cost of service(s) provided
  • Nominal charge is not more than the first pay class above 100% of the FPG
  • external patient satisfaction surveys

  • feedback from board members who are patients

Definitions of Income and Family Size

Eligibility for Sliding Fee Discounts for all patients are based on income and family size and no other factors.

UHP uses the US Census Bureau definitions of each.

UHP's Sliding Fee Discount Schedule (SFDS) Program

SFDS Administration

PIN Requirement:

The health center has written policies and supporting operating procedures for it SFDS program.

Family is defined as: a group of two people or more (one of whom is the head of household) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family.

  • The SFDS Program is administered by the PSR & SFS Coordinator.
  • SFDS documents and patient charts are audited and reviewed for compliance each month.
  • The program is reviewed and policy is updated annually.

Income includes: earnings, unemployment compensation, workers' compensation, Social Security, Supplemental Security Income, public assistance, veterans' payments, survivors benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, alimony, child support, assistance from outside the household, and other misc. sources.

Methods for making patients aware of the availability of discounts:

  • UHP is committed to improving the health & wellness of under served communities and vulnerable populations.

  • It is our policy to provide necessary medical services regardless of the person's ability to pay.

  • The SFDS Program adheres to the Sliding Fee Discount & Related Billing and Collections Program Requirements PIN 2014-02
  • Signs posted at each site's waiting area/front desk

  • Flyers describing the program will be distributed to every new/established patient

  • UHP's website

All methods are in both Spanish & English

PIN Requirement:

Health center has systems in place to make reasonable efforts to collect and receive reimbursement its costs in providing health services.

Billing & Collection (SFDS Program)

UHP will bill the patient any self pay portion they owe ( Ex: Outstanding balances, Co-payment, coinsurance, and/or deductible).

UHP will make a reasonable effort to collect payments from patients in an efficient, respectful and culturally appropriate manner.

UHP will assure that the collecting procedures do not present a barrier of care and the patient's privacy and confidentiality are protected throughout the process.

PIN Requirement:

These systems include written policies and procedures addressing billing and collections.

Provisions for Waiving Charges

Charges may be waived for certain qualifying patients with specific criteria:

  • Adolescents (13-18) seeking reproductive services
  • Health education services
  • Enrolled patients awaiting subscriber number
  • Copayments will be waived for UHP employees that are patients enrolled in the group plan
  • Uninsured members of religious orders

The PSR & SFS Coordinator and Site Administrators have the authority to approve the waiving of charges.

Financial Hardships

  • Payment plans can be made to assist the patient in paying off their balance.
  • Each plan will vary and be molded to fit each patient's individual needs.
  • Each plan is reviewed by the PSR & SFS Coordinator.
  • Payment plans are accessible to all patients.

Form 5A, Columns 1-3

  • All services for which there is an established charge are discounted in accordance to the health center's SFDS Program.

  • The written agreements between UHP and outside organizations/providers describe how contracted services provided to health center patients will be discounted in accordance to the SFDS Program.

  • Referred services are discounted for health center patients in accordance to the SFDS criteria or in a manner that provides greater discounts.

Pin Requirement:

PIN Requirement:

The health center assesses all patients for eligibility for sliding fee discounts and applies the discounts accordingly.

All required and additional services within a health center's approved scope of project are available to health center patients regardless of ability to pay through a SFDS program.

Evaluation of SFDS Program

Documentation/ Verification Requirements:

An annual survey of program users will be conducted to ensure fees are fair and receive feedback on how to improve the program.

PIN Requirement:

  • Patient must fill out the SFDS Application

  • Patient must bring in Proof of Income Document by next visit

  • Patient must apply for program on an annual basis

Patients with Third Party Coverage Who are also Eligible for SFDS Program

The health center has a system in place to adjust fees on the basis of the patient's ability to pay.

  • Insured patients are now able to receive discounts on their co-payments, coinsurance and/or deductible.

  • All insured patients that are eligible for the program are charged no more than they would owe under the SFDS.

Assessment:

  • All new patients are assessed for family size and income during the intake process.
  • All established patients are assessed for family size and income each year during their Annual Psychosocial Assessment.
  • Any patient can be assessed for the SFDS program anytime during working hours at the Cashier's desk.
  • Patients are informed in person of their eligibility for the SFDS program.
  • Patients have the right to decline assessment.
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