5THA - Mountain Health Center
Sliding Scale Policy
Purpose:
The purpose of this policy is to establish a consistent method for determining eligibility for our Sliding Scale Program for patients at Mountain Health Center (MHC)
Policy:
The Sliding Fee Discount Program (SFDP) shall be offered to all eligible patients in compliance with the PHS Section 330 funding guidelines Federally Qualified Health Center (FQHC) governmental guidelines as applicable.
Eligible patients are those residing in our service area and are patients of the Health Center who meet income guidelines established each year.
The SFDP is intended to be used by MHC patients only after all other sources of payment for services have been applied to fees owed. Patients should be informed that they should apply for Vermont Medicaid at the time they are applying for the SFDP so they may be covered by Vermont Medicaid for health care services received by entities other than MHC and for services at MHC in the future, should they be Medicaid eligible. (An application for Medicaid is not a pre-condition for receiving sliding scale on the date of service.)
If a patient has private insurance or is eligible for State Medicaid, or other state health insurance and chooses not to access this insurance, MHC retains the right to disallow any discounts on fees.
The program is based on federal poverty guidelines and is applied in a consistent manner to all applicants.
Procedure:
1. SFDP information shall be available at all MHC facilities at all times and a sign shall be posted notifying patients of the availability of the SFDP.
2. Applications for the SFDP shall be available from the billing office and should be provided to all patients new to MHC when they register.
3. Once qualified, there is no waiting period for sliding scale discounts, and discounts may be applied to patient charges incurred up to six months prior to the date of the application if approved by Executive Director or designee.
4. Applications shall be accepted at any time during the year, however, all enrollments will expire Sept 30 of each year and a new application must be submitted and approved each year. Only one application per year is required to qualify for sliding scale at all MHC sites.
5. Applicants must provide proof of primary residency in VT through any one of the following: valid Vermont Driver’s license; voter registration; or a copy of current year Vermont State income tax return or other documents such as an electric bill. A post office box is not sufficient to prove town of residence.
6. Applicants shall be required to submit a completed application form and copy of their federal tax return for the most recent filing period if they are self-employed or two copies of their most recent pay stubs for all employed individuals in the family. The executive director or designee may waive the requirement of a federal tax return if, for valid reasons, the applicant is not required to file one, and can substitute other documentation of family income such as child support, social security check, payroll check stub, etc.
7. Assignment of sliding scale categories shall be based on family size (including students away at college but still claimed as dependants) and household income in accordance with the most recent federal poverty guidelines. The executive director or designee may take into account special circumstances when setting a patient’s sliding scale category. Patients or providers wishing to have special circumstances considered in the assignment of a sliding scale category must submit an explanation in writing.
8. Patients shall be notified in writing regarding whether or not they qualify for sliding scale and what percentage they will receive. All patient information regarding the SFDP shall be held in strict confidence.
9. A random sample of at least 10 sliding scale applications shall be reviewed at least once each fiscal year by the compliance officer or designee to assure compliance with application guidelines and discount assignment criteria.
10. If it is determined that an applicant or enrollee in the SFDP has willfully or knowingly provided false or fraudulent information in his/her sliding scale application, the applicant or enrollee shall be ineligible for sliding scale discounts for the remainder of the current sliding scale year and for the subsequent sliding scale year.
11. Patients enrolled in the SFDP who move out of the designated sliding scale area will be allowed to continue sliding scale reductions until the end of the current sliding scale year, but will not be eligible for renewal in the subsequent year.
12. Patients living in the same home, who do not file joint tax returns and are not responsible for each others bills may apply separately and qualify separately for the sliding scale discount.
Enrollment of Minors:
1. A patient who is under 18 years of age shall be considered as an individual for enrollment in the Sliding Scale Program only under the following criteria:
· Patient is here for STD, pregnancy, or birth control and wishes confidentiality.
· Mature minor – if the minor has been living separately from his/her parents or legal guardian for 60 days and is independent of parental support; or if the minor is or was legally married; or if the minor is or was a member of the Armed Forces; or if the minor has been declared emancipated by the court.
Enrollment of 18-26 Year Old Dependants
If the patient is 18-26 years of age and living at home with his/her parents and is claimed on parents’ tax return as a dependant, he/she will be included as part of the family and may not apply for the Program as an independent person.
Exceptions and Clarification of Nominal Fees
A flat rate nominal fee of $25 will be charged to all patients under 100% Federal Poverty Level (FPL) for services rendered. This fee can’t be higher than the amount the patient would pay if they were in the first tier of the sliding fee discount. If at any time MHC or MHC finds there are any barriers to potential patients in receiving care, we will reassess this policy nominal fee.
MHC Sliding Fee Scale for Primary Care (Based on 2013 Federal Poverty Levels)
Annual Family Income RangeHousehold Size / Below 100% FPL / 101-125% FPL / 126-150% FPL / 151-175% FPL / 176-200% FPL / Over 200% FPL
Discount Applied / $25 Flat Fee / 80% Discount / 60% Discount / 40% Discount / 20% Discount / 0% Discount
1 / Under $11,490 / $11,491-14,363 / $14,364-17,235 / $17,236-20,108 / $20,109-22,980 / Over $22,980
2 / Under $15,510 / $15,511-19,388 / $19,389-23,265 / $23,266-27,142 / $27,143-31,020 / Over $31,020
3 / Under $19,530 / $19,531-24,412 / $24,413-29,295 / $29,296-34,178 / $34,179-39,060 / Over $39,060
4 / Under $23,550 / $23,551-29,438 / $29,439-35,325 / $35,326-41,213 / $41,214-47,100 / Over $47,100
5 / Under $27,570 / $27,571-34,463 / $34,464-41,355 / $41,356-48,248 / $48,249-55,140 / Over $55,140
6 / Under $31,590 / $31,591-39,488 / $39,489-47,385 / $47,386-55,283 / $55,284-63,180 / Over $63,180
7 / Under $35,610 / $35,611-44,512 / $44,513-53,415 / $53,416-62,317 / $62,318-71,220 / Over $71,220
8 / Under $39,630 / $39,631-49,538 / $49,539-59,445 / $59,446-69,353 / $69,354-79,260 / Over $79,260
Additional People / Add $4,020 per person / Add $5,026 per person / Add $6,030 per person / Add $6,930 per person / Add $8,040 per person / Add $8,040 per person
Created – Sept 2012
Approved – BOD 11/05/2012
Updated – 06/07/13 with 2013 FPL guideline
Updated – 01/01/14 reviewed language / proposed lower flat fee
4