Sliding Fee Scale and Ability to Pay Programs


2022-2023 Sliding Fee Scale.

High Plains Community Health Center will offer medical, laboratory, x-ray, pharmacy, behavioral health, and dental services and ensure no patient is denied care based on an inability to pay.

Federal Poverty Levels (FPL) are released yearly by the Federal Government. The Board of Directors will approve the Ability to Pay Scale annually based on the FPL with plans in place for routine evaluation annually of the SFS to ensure that it does not create a financial barrier to care.

1. All patients seeking healthcare services at High Plains Community Health Center 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, whether they have qualified for a discount or not.

2. Outreach Workers and other staff will be employed to determine eligibility for various programs, assist patients with applications and provide translation services, as necessary.

3. Patients who qualified for High Plains Sliding Fee Scale will be immediately eligible for the discount identified in accordance with the Sliding Fee Scale discounts and nominal fee on the Exhibit B­Sliding Fee Scale Nominal Fee Schedule.

4. Notification: High Plains Community Health Center will notify patients of the Sliding Fee Discount Program by:
     a. Patient handbooks will be given to new patients (Dental, BH, Medical) at time of appointment and available at all greeter stations that explain the Sliding Fee Discount Program.
     b. An explanation of our Sliding Fee Discount Program is available on the High Plains Community Health Center website.
     c. Sliding Discount Program signs are hung in all clinic waiting areas.

5. Collections: High Plains Community Health Center will make every reasonable effort to collect all charges for services rendered, regardless of whether discounted charges are applied. Reasonable efforts to collect may include, but are not limited to, issuance of a bill, collections letters, telephone calls and sending patient to a 3rd party collection agency.

6. Eligibility CICP: Discounts will be based on the most current Federal Poverty Guidelines published by the Department of Health and Human Services for the CICP program.
     a. Family- is defined as: a group of two people or more related by birth, marriage, or adoption; all such people (including subfamily members) are considered as members of one family.
     b. Income- includes: earnings, unemployment compensation, worker's compensation, Social Security, Supplemental Security Income, VA benefits, survivor benefits, pension or retirement income, interest, dividends, rents, royalties. Non cash benefits (such as SNAP and housing subsidies) do not count.
     c. Enrollment into the Sliding Fee Scale must be completed on an annual basis or more frequently if the patient's income status has changed.
     d. Copies of all documents provided to High Plains Community Health Center for the determination of eligibility will be retained by High Plains Community Health Center for five years.
     e. Allowable Deductions: adult care, day care, elderly care, paid alimony, child support, health insurance premium(s), pharmaceuticals, use of personal vehicle for business purposes and outstanding medical bills.

7. Eligibility HPC: Discounts will be based on income and family size only. High Plains Community Health Center uses the Census Bureau definitions of each
     a. Family- is defined as: a group of two people or more related by birth, marriage, or adoption; all such people (including subfamily members) are considered as members of one family.
          i. Married couples that are separated may do a declaration for their spouse's income if they cannot provide their actual income. Married couples who are currently separated do not have to obtain legal documentation of separation or divorce
     b. Income- includes: earnings, unemployment compensation, worker's compensation, Social Security, Supplemental Security Income, VA benefits, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, and trusts. Non cash benefits (such as SNAP and housing subsidies) do not count. Pay stubs oflast month's income is the verification of choice. If the patient is unable to supply this, a written verification from their employer is acceptable.
          i. Earned income from a working minor (under the age of 18 years) is exempt.
     c. Enrollment into the Sliding Fee Scale must be completed on an annual basis or more frequently if the patient's income status has changed.
     d. Copies of all documents provided to High Plains Community Health Center for the determination of eligibility will be retained by High Plains Community Health Center.
     e. Self-declaration oflncome may only be used in many circumstances including: being homeless, unemployed, and patients' that are unable to provide written verification must provide a signed statement of income and why they are unable to provide independent verification. The outreach department makes every effort to make sure patients bring in proof but if they don't have it they are able to declare it.
     f. A nominal fee will be charged to all patients who qualify for the HPC Sliding Fee Scale program. No discounts will be provided to an individual or family whose income exceeds 250% of the Federal Poverty Guidelines.
     g. HPC Schedule for details on the discounts and nominal fees: the following nominal fees based on family size and income
          i. Level C: $10 dollar nominal fee for medical and behavioral services, and $30 nominal fee for dental services for those who are under 100% of the FPG. If the patients do not have the funds for the nominal fee, the center will use our discretion as to whether it will be waived. Family planning services will have a zero dollar copay.
          ii. Level D: $20 fee charged for those between 101 %-117% for medical and behavioral health. 40% fee charged for those between 101 %-117% for dental.
          iii. Level E: $24 fee charge for those between 118%-133% for medical and behavioral health. 50% fee charged for those between 118%-133% for dental.
          iii. Level F: $25 fee charge for those between 134%-159% for medical and behavioral health. 60% fee charged for those between 134%-159% for dental.
          iv. Level G: $34 fee charge for those between 160%-185% for medical and behavioral health. 70% fee charged for those between 160%-185% for dental.
          iv. Level H: $35 fee charge for those between 186%-200% for medical and behavioral health. 80% fee charged for those between 186%-200% for dental.
     h. The Board of Director that are HPCHC patients will discuss the determination of the nominal fee to make sure it is nominal and that the financial barriers to care are minimized. This will be done yearly.
     i. Allowable Deductions: adult care, day care, elderly care, paid alimony, child support,health insurance premium(s), pharmaceuticals, use of personal vehicle for business purposes, outstanding medical bills.

8. If a patient is insured by a public or private third-party payer and the patient's cost-sharing amount is more than the amount that would have been charged as an uninsured patient that participates in the Sliding Fee Discount Program (SFDP), the health center will reduce the cost-sharing amount to the applicable SFDS level as permitted by the public or private third-party payer contract.

9. High Plains Community Health Center ensures that all services within our approved Scope of Project regardless of the mode of delivery (in house, via contract) will be offered a sliding fee scale discount for patients who meet qualifying criteria.

10. Non-covered services are as follows: lab fees for dentures and crowns. Non covered list of lab

11. Enrollment for the following programs will be available at HPCHC:
     a. COLORADO INDIGENT CARE PROGRAM (CICP): State sponsored program for Colorado Residents for discounted medical and behavioral health services based on family size and income less than 250% FPL and other CICP eligibility policy. Office visits for a co-pay, formulary prescription benefits, and other visits will be offered according to CICP Client Copayment Table. Eligibility will be based on the current CICP Manual and will be reevaluated yearly or sooner if income changes. Accepted by HPCHC, PMC & other hospitals within the state. Could also include a once/year/family Emergency Application based on verbal family size and income for urgent care. Accepted by HPCHC only.
     b. HPCHC SLIDING SCALE DISCOUNT: In-house program for non-Colorado residents, undocumented patients, and dental patients for discounted services based solely on family size and income less than 200% FPL. Medical, behavioral health, and chiropractic/acupuncture office visits for a nominal fee or copay, dental services for a nominal fee or percent of discount, and formulary prescription benefits will be offered on a sliding fee scale approved by the HPCHC Board of Directors. Eligibility will be based on the current CICP guidelines, but will not include any eligibility requirements other than family size and income (i.e. will not include CICP requirements for residency or asset testing).
     c. MIGRANT PROGRAM DISCOUNT: In-house program for migrant or seasonal farmworkers for discounted services based on family size and income less than 200% FPL. Level N will be assigned to all eligible. Medical, behavioral health and chiropractic/acupuncture office visits for a copay, dental discounts, and formulary prescription benefits based on a sliding fee scale approved by the HPCHC Board of Directors. Eligibility will be based on migrant status and verbal family size and income. Accepted by HPCHC only.
     d. CHILD HEALTH PLAN PLUS (CHP+): State sponsored health insurance for children 0-18 years old. Premiums and copays based on family size and income. Covers office visits, hospital, mental health, $150 allowance for eye care and most prescriptions, and a $1000 dental benefit. Eligibility will be based on current CHP+ guidelines and determinations will be made by the CHP+ Program. Accepted by all area doctors, hospitals, and some eye care providers.
     e. MEDICAID: State sponsored program covers office visits, hospital care, mental health, prescriptions, and some dental and vision services. Eligibility will be based on current Medicaid guidelines and final determinations will be made by the Medicaid Program.
     f. TEEN SERVICES-COLORADO INDIGENT CARE PROGRAM (CICP): State sponsored program for Colorado Residents for discounted confidential adolescent care up to the patient's 20th birthday (limited to: birth control, pregnancy testing, venereal disease, drug use, drug addiction, mental health services) Eligibility will be based on the current CICP guidelines, but will not include CICP residency requirements or asset testing. Covers office visits, related laboratory or injectable for a Level N copay (all income levels <200% FPL) and related formulary prescription benefits.
     g. WELL WOMENS CONNECTION (WWC}: State/Federal sponsored program for Colorado Residents for free breast and cervical cancer screening for women based on age, family size and income less than 250% FPL. Eligibility will be based on current WWC guidelines.
     h. CONNECT FOR HEALTH COLORADO: A marketplace to help individuals, families and small employers across Colorado purchase health insurance and apply for new federal financial assistance to reduce costs. In addition to the shopping website, Connect for Health Colorado offers a statewide customer support network of Customer Service Center Representatives, Health Coverage Guides and licensed agents/brokers to help Coloradans find the best health plan for their needs. Connect for Health Colorado is the only place where Coloradans can apply for advance premium tax credits and cost-sharing reductions to help pay for commercial insurance coverage.
     i. FAMILY PLANNING: State/Federal sponsored program for patients for free contraception services for women and men based on age, family size and income less than 100% FPL.