Self Pay/Sliding Fee Schedule Discount Program | West Volusia Hospital Authority (WVHA) | Affordable Care Act (ACA) | Medicaid |

Self Pay/Sliding Fee Schedule Discount Program

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Northeast Florida Health Services, Inc. (NEFHS), dba Family Health Source, maintains a standard procedure for qualifying patients for sliding fee scale discounts for services provided.  Sliding fee scale discounts are available to all patients in accordance with the federal poverty guidelines.  Full Sliding Fee Scale discounts are available to those with an annual income at or below one hundred percent (100%) of the current Federal Poverty Guidelines. Family Health Source will base program eligibility on a person’s ability to pay and will not discriminate on the basis of age, gender, race, sexual orientation, creed, religion, disability, or national origin.

For those individuals who fall outside of the income guidelines for a Sliding Fee Scale discount, those patients would be seen at full cost/self-pay. Sliding fee scale discounts apply to all services provided by Family Health Source, and for all in-scope services.

In addition to quality healthcare, patients are entitled to financial counseling by someone who can understand and offer possible solutions for those who cannot pay in full. The case manager’s role is that of patient advocate, that is, one who works with the patient and/or guarantor to find reasonable payment alternatives.

Family Health Source ensures that:

  1. Patients are made aware of the Sliding Fee Discount Program.
    • All locations will display in English and Spanish that we offer a discount program;
    • Information and advertisement on org outlines our sliding fee schedule and program which is updated on our website and maintained by our IT (information Technology) and Marketing departments;
    • Social media websites also will contain information regarding this program and will be maintained by our Marketing Department;
  2. Eligibility for discounts is based on income and family size and no other factors (e.g., assets, insurance status, participation in the Health Insurance Marketplace, citizenship, or population type).

Purpose:  To ensure that any  patient receive quality medical care based on their household/family size and income regardless of their ability to pay in accordance with Federal Poverty Guidelines.  It is the policy of Family Health Source that no patient be denied services based on their ability to pay.  Any patient will be given an application and information pertaining to Federal Poverty Guidelines for purposes of eligibility. Family Health Source Sliding Fee Scale Policy ensures that patients have access to all primary care services regardless of their ability to pay.  In compliance with HRSA guidelines, Family Health Source supports the concept that patients can be monetarily invested in their care based on their ability to pay.  Its implementation is intended to minimize financial barriers to care for patients according to the Federal Poverty Guidelines. Therefore, neither the fees themselves nor the supporting operating procedures for assessing patient eligibility and collecting payment should create barriers to care.

Definition:

  • Family income: 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.
  • Household size: The number of persons for whom you are financially responsible.
  • Family: 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.
  • Income: Income includes:  earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources.  Noncash benefits (such as food stamps and housing subsidies) do not count.

Procedure:  All employees are responsible for assisting patients to see which sliding scale discount a patient may qualify under.  We offer discounts from 100% to full pay.  This is not an insurance plan, but a discount program that is only valid at a Family Health Source location.

 

  1. The Front Desk Specialist also informs patients in appropriate language that they have the option to apply for a sliding fee scale discount. Signage and the Family Health Source website (org) also will communicate the availability of a sliding fee scale discount.  The sliding fee scale also can apply for co-payments, deductibles and coinsurance.

 

In order to qualify, the patient must share family and gross income information.  A family consists of those members of the household supported by the reported income, typically the individuals reported on the federal tax return.  If a patient is married, both the patient and their spouse’s income need to be provided to determine the correct scale.  If he/she agrees to begin the qualification process, the Front Desk Specialist asks the patient to complete the sliding fee scale application and provide any of the following documentation of gross income for all household members:

 

  • Federal income tax return
  • The patient will need to recertify on or before April 15th of the following year
  • Most recent paystubs showing one (1) month of income, or
  • The patient will need to recertify every 6 months
  • Unemployment benefit award letter, or
  • The patient will need to recertify every 6 months
  • Letter from employer on letterhead, or
  • The patient will need to recertify every 6 months
  • Award or benefit letter, or
  • The patient will need to recertify every 6 months
  • Affiliated agency income verification documentation that meets above requirements, or
  • The patient will need to recertify every 6 months
  • Notarized verification of income form
  • The patient will need to recertify every 6 months

 

Patients must recertify according to this schedule by providing new/updated income and family documentation.

 

Patients that do not wish to apply for a sliding fee scale discount will be asked to attest to income and household size to be compliant with UDS reporting.  Patients that refuse to be assessed will be billed full charges for their services.

 

Note:  A patient is still eligible for sliding fee if their residency status is unknown or they are disqualified from government benefits.

 

  1. The patient is eligible for a sliding fee discount when all documentation is received and income criteria for discounts are met. Documentation is scanned into the patient’s electronic medical record under the insurance information.  The income and family information are entered into Athena Health to determine the appropriate scale.

 

  1. Using the attached sliding fee scale, the specific amount of discount is determined for which the patient is eligible. The sliding fee scale will be reviewed and/or updated annually when the federal poverty guidelines are published in the federal register and the Family Health Source Board of Directors approves any changes.

 

  1. The patient’s account is updated in our EMR/EHR system (Athena Health) to reflect eligibility for sliding fee scale discounts, and the level of discount for which the patient has qualified.

 

  1. Family Health Source has elected to impose a nominal fee of $25.00 (twenty-five dollars) for patients at or below 100% of the currently Federal Poverty Guidelines. The nominal fee is reviewed annually in accordance with FPG, local competitive rates and feedback from the patient surveys.

 

  1. Patients that are unable or do not have all their documentation at the time of service will be processed in the following manner.
    a. We offer a onetime nominal fee of $25.00 (twenty-five dollars) for the first visit for all patients. This gives the patient time to gather necessary eligibility documentation if it is not available      at the time of the initial appointment.  The patient will be given a checklist before leaving the office of what documentation is needed on or before their next office visit.
    b. If the patient comes in for another visit and eligibility has not been determined due to missing documentation, the patient then will be charged a discounted rate based on a 60% (sixty               percent) discounted rate. Once again, they will be given a check list of missing documentation.
    c. For any future visits (past the first and second) at Family Health Source, if the patient has failed to provide the necessary documentation to determine eligibility for the sliding scale                    discount program, they will be charged at full pay until documentation is provided.

 

  1. Patients who qualify for certain levels of sliding fee discounts also are expected to apply for other programs.
  2. Medicaid: All patients applying for sliding scale discounts are expected but not required to also apply for Medicaid if the patient appears to have a category for eligibility;
  3. Other public and/or private health insurance and/or discount programs available for which the patient may qualify, including prescription drug assistance from pharmaceutical companies.

 

  1. While a patient is awaiting their determination of eligibility from Medicaid, he/she will be offered sliding fee scale services based on their presumptive income, IF all other documentation is complete.

 

  1. Patients will be asked for payment at the time of service. It will be explained that they are expected to pay, may receive a bill or we can set up a payment plan if they are not able to pay at the time of service.  Fees for patients who qualify for sliding fee scale discounts are indicated on the Board-approved sliding fee scale discount schedule, which is reviewed, updated and approved annually.  Nominal fees may be waived or reduced if the patient meets the requirement of Family Health Source copay waiver/reduced fee policy.  The Chief Executive Officer (CEO) and/or Comptroller can waive the fees for certain individuals.  A permanent waiver can be provided if a patient can provide third party certification of homeless status.  To obtain this waiver, the patient also must meet with the Case Management Department for evaluation of need and community assistance.

 

Our policy of collecting any monies due at the time of service is posted at each location.  In the event that the patient states they are unable to pay, the Front Desk Specialist will provide the patient with the Wavier/Reduced Fee Form or offer a payment plan.

 

  • The above must be approved according to Family Health Source policy then scanned into the patient’s chart.

 

  1. Family Health Source will maintain a uniform process for sliding fee discount program applications and patients must be re-qualified for sliding fee scale discounts biannually or annually depending on the type of documentation initially reviewed. The patient can do this by providing new/updated income/family documentation.

 

  1. The Family Health Source Board of Directors will review and approve the schedule of fees for services based on costs and market rates.

 

  1. All patients seeking healthcare services at Family Health Source are assured that they will be served regardless of ability to pay. No one is refused service because of lack of financial means to pay.

 

  1. Annually, the amount of Sliding Fee Discount Program service provided will be reviewed by the CEO and/or Comptroller. The sliding fee scale will be updated based on the current Federal Poverty Guidelines.  Pertinent information comparing amount budgeted and actual community care provided shall serve as a guideline for future planning.  This also will serve as a discussion base for reviewing possible changes in our policy and procedures and for examining institutional practices which may serve as barriers preventing eligible patients from having access to our community care provisions.

 

During the annual budget process, an estimated amount of Sliding Fee Discount Program service will be placed into the budget as a deduction from revenue.  Board approval for Sliding Fee Discount Program service will be sought as an integral part of the annual budget.