HRSA requirements for a compliant sliding fee scale

The Health Center Compliance Manual outlines the requirements of both the program legislation and implementing regulations. The most recent updates to the Manual from HRSA provided some needed clarification in a number of areas, including the Sliding Fee Discount Program that is central to the Health Center Program. This webinar will outline the Sliding Fee requirements and provide examples and best practices for Community Health Centers to consider.

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HRSA Requirements for a Compliant 
Sliding Fee Scale
HRSA Requirements for a Compliant 
Sliding Fee Scale
Presented January 8, 2020
by Steven D Weinman
Speaker’s Bio: Steve WeinmanSpeaker’s Bio: Steve Weinman
•1984‐2013, employed at large CHC in SW FL
•Began as IT director, produced custom PM 
•Served as CFO, then EVP/COO, oversaw all employees except CEO
•Founding CEO 18 Member HCCN 
•CEO of start up health center in Broward County, FL
•Founding Treasurer of Integral Quality Care Managed Care Plan
•Board Treasurer, National Center for Farmworker Health
•HRSA reviewer and consultant
•1984‐2013, employed at large CHC in SW FL
•Began as IT director, produced custom PM 
•Served as CFO, then EVP/COO, oversaw all employees except CEO
•Founding CEO 18 Member HCCN 
•CEO of start up health center in Broward County, FL
•Founding Treasurer of Integral Quality Care Managed Care Plan
•Board Treasurer, National Center for Farmworker Health
•HRSA reviewer and consultant
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DisclaimersDisclaimers
This presentation was prepared by Consultants at AITHOZ, utilizing materials generally available to the public and
other sources. Any opinions expressed are those of the presenter. AITHOZ,Compliatricoranyotherpartyinvolved
in this presentation guarantee the accuracy of the information presented, nor is responsible for any issues or
damages resulting from any miscommunication, error or omission contained within.
AITHOZ is not a law firm, and nothing contained either in the written materials, or in any commentary by AITHOZ or
others during the presentation should be construed as legal advice. If legal or other expert advice is required, legal
or other competent professionals should be engaged.
Every health center is different. Information and examples contained in this presentation are not intended to cover
all potential situations, rules or policies. Laws, regulations and policies are subject to change, with or without notice.
This presentation was prepared by Consultants at AITHOZ, utilizing materials generally available to the public and
other sources. Any opinions expressed are those of the presenter. AITHOZ,Compliatricoranyotherpartyinvolved
in this presentation guarantee the accuracy of the information presented, nor is responsible for any issues or
damages resulting from any miscommunication, error or omission contained within.
AITHOZ is not a law firm, and nothing contained either in the written materials, or in any commentary by AITHOZ or
others during the presentation should be construed as legal advice. If legal or other expert advice is required, legal
or other competent professionals should be engaged.
Every health center is different. Information and examples contained in this presentation are not intended to cover
all potential situations, rules or policies. Laws, regulations and policies are subject to change, with or without notice.
What will we discuss today? What will we discuss today?
•Why do FQHCs have a Sliding Fee Scale
•Where do we find the rules
•What are the basic requirements?
•Demonstrating compliance (the details)
•Additional Considerations‐Food for thought
•Questions and Wrap‐Up
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Why is there a sliding fee scale?
The Center “has prepared a schedule of fees or payments for the provision of its services consistent with
locally prevailing rates or charges and designed to cover its reasonable costs of operation and has
prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments,
which discounts are adjusted on the basis of the patient’s ability to pay”
This system “will assure that no patient will be denied health care services due to an individual’s inability to
payfor such services; and will assure that any fees or payments required by the center for such services
will be reduced or waived …”
Section 330(k)(3)(G) of the PHS Act REQUIRES it, specifically:
Where do we find the rules?
2014
(Outdated)
2018 2019
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Basic Requirements
Demonstrating Compliance:
Applies to all services
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Board Approved Policies
SFDS Structure
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Multiple SFDS and FPG/Patient Re-
Assessment
Informing Patients of SFDS
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In-Scope Contractual Services Treated the
Same as Directly Provided Services
In-Scope Referrals
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Discounts for Insured Patients
Evaluates Program at Least Once Every 3
Years
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Related (Discretionary) Considerations
Related (Discretionary) Considerations
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Related (Discretionary) Considerations
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Patient’s “family” Income
What
constitutes a
Family?
Patient’s “family” Income
What does
ability to pay
mean?
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Patient’s “family” Income
How much
is
“nominal”
?
How does this
affect the
patients and
the health
center?
Patient’s “family” Income
How many
categories?
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Patient’s “family” Income
We need at
least 3
between
100%-200%
FPL
Patient’s “family” Income
We have a
problem!
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Patient’s “family” Income
4 categories
100%-200%
FPL (6 Total)
4 categories
100%-200%
FPL (6 Total)
Discount
Pa#ent Pays
Are the health
center fees
market based?
Do we want to give
a “prompt-pay”
discount?
$150
$110
$40
$100
Dr. Dooli( le
Clinic
Mary
<100%
FPL
Jane
>200%
FPL A Tale of 2
Patients
Patient Pays
Discount
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=XX%=XX%
What it means:
In general, a higherpercentage is better
because:
• The center is providing more care to the
target population
• The center is more likely to maintain or
increase HRSA funding in the future
Total annual Sliding Fee Discounts
Total ongoing budget
Sliding Fee Discounts
Common HRSA OSV Findings
•No documentation that the board has approved the sliding fee scale annually
•Eligible insured patients not offered sliding fee discount on non-covered
items (i.e. Dental)
•No written policies and/or procedures
•No documented assessment done to assure that the center’s policy is not
proving to be a barrier to care
•Sliding fee discounts provided to patients above 200% FPL
•Most common incorrect finding:Center should be offering all services (i.e.
Dental) on the same fee schedule
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Questions and Wrap UpQuestions and Wrap Up
Steven D Weinman
Senior Consultant
239.850.1754
[email protected]
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