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Sliding Fee Scale Discount Summary


Sliding Fee Scale Discount Summary

General Rules

  • Discount must be offered to all patients who meet eligibility criteria
  • Eligibility criteria must be developed from the Federal Poverty Guidelines(FPG), based on family size and income
  • Sliding scale policy must be updated annually (As FPG is updated annually)
  • Discounts apply to any amount due from patients
  • Discounts need to be all inclusive, covering visits, procedures, etc.

Fee Scale

  • Discounts to all patients below 200% Federal Poverty Level (FPL)
  • Patients at or below 100% of FPL will receive a full 100% discount
  • Patients at or below 200% of poverty, will be charged according to the attached sliding fee schedule. The sliding fee schedule will be updated during the first quarter of every calendar year with the latest federal poverty guidelines, http://aspe.hhs.gov/poverty. However most organizations require a nominal fee (Nominal fee varies, but $10 seems to be the most common fee for medical services. Other organizations varied from $2-$20 for medical services).

Determining Eligibility for Discounts

  • The collection of family size and income information from all patients must be a part of the usual registration process
  • Patients who decline to offer this information are ineligible for a discount
  • Grace periods are given to patients without the required documentation (A standard time frame for the grace period was not found, but several organizations allow patients 2 weeks and one allows 30 days).
  • Discounts are granted to patients on their initial visit based on self-reporting (Documentation is not required)
  • Discount application form is separate from registration form
  • Discount application form is completed on initial registration and is updated at least once per year

Required Documentation for Discounts

  • Proof of Income (If Employed) One of the Following:
    • 1040
    • W2
    • 2 recent pay stubs
    • Written statement by employer
  • Proof of Income (If Unemployed) One of the Following:
    • Public Assistance check stub/copy
    • Social Security check stub or letter of award
    • Certification Letter from Medical Assistance or Department of Social Services
    • Completed zero income form
    • Written statement from friend or relative with whom patient lives (if other forms not available)
    • Letter of reference from a 501 (c)(3) organization, such as a church (if other forms not available)
  • Proof of Address One of the following:
    • Driver’s license
    • MVA ID,
    •  Any document (envelope) recently addressed to patient such as a utility bill
    • A written statement by relative or friend with whom patient lives
  • Proof of Address (Immigrants) One of the Following:
    • Form 1551
    • Form 194
  • Recertifying Clients for Discount​
    • Patients are re-certified at least once per year, some organizations require re­certification every 6 months
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Ashland Health Center625 Kentucky St.Ashland, KS  67831

p. 620.635.2241f. 620.635.2229

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