Consumer Sliding Fee Discount Program Policy

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Effective Date: January 1, 2023 

Purpose: All consumers seeking health care services at Renew Counseling, Consulting, and Wellness Services are informed that services will be provided to them regardless of ability to pay. No consumer is refused service because of their lack of financial means to pay. The practice is designed to provide discounted services to consumers who have no means or limited means to pay for their health care services (uninsured or underinsured). Renew Counseling, Consulting, and Wellness Services will offer a Consumer Sliding Fee Discount Program to all consumers who are unable to pay for their services. Renew Counseling, Consulting, and Wellness Services will base program eligibility on a person’s ability to pay and will not discriminate based on an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. The Federal Poverty Guidelines are used in creating and annually updating the sliding fee schedule to determine eligibility. 

Procedure: The following guidelines are to be followed in providing the Sliding Fee Discount Program. 

1. Notification: Renew Counseling, Consulting, and Wellness Services LLC will notify consumers of the Sliding Fee Discount Program by:

• An explanation of Renew Counseling, Consulting, and Wellness Services Consumer Sliding Fee Discount Program is available on practice website. 
• Sliding Fee Discount Program application will be included with collection notices sent out by Renew Counseling, Consulting, and Wellness Services. 
• Notification of the Sliding Fee Discount Program will be offered to each consumer upon admission to services.

2. Request for discount: Requests for discounted services can be made by consumers, family members, social service providers, or others who are aware of existing financial hardship. The Consumer Sliding Fee Discount Program will only be made available for practice visits. Information and forms can be obtained from the practice business office. 

3. Administration: The Consumer Sliding Fee Discount Program procedure will be administered through the practice office manager or his/her designee. Information about the Consumer Sliding Fee Discount Program policy and procedures will be provided to consumers. Staff are to offer assistance with completing the application. Dignity and confidentiality will be respected for all consumers who seek and/or are provided with health care services. 

4. Completion of Application: The consumer/responsible person must complete the Consumer Sliding Fee Scale Discount Program application in its entirety. Staff will be available on an as needed basis to assist consumer/responsible person with applications. By signing the Consumer Sliding Fee Scale Discount Program application, the applicant is confirming their income to Renew Counseling, Consulting, and Wellness Services as disclosed on the application.

5. Eligibility: Discounts will be based on income and family size only. 

• Family is defined as: a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption residing together. All people (including related sub-family members) are considered as members of one family. Renew Counseling, Consulting, and Wellness Services will also accept non-related household members when calculating family size. 
• Income includes: gross wages, salaries, tips, income from business and self-employment, unemployment compensation, workers' compensation, Social Security, Supplement Social Security income, interest, dividends, royalties, income from rental properties, estates, trusts, alimony, child support, assistance from outside the household, and other miscellaneous sources. 

6. Income verification: Applicants may provide one of the following: prior year W-2, two most recent paystubs, letter from employer, or Form 4506-T (if W-2 not filed). Self-employed individuals will be required to submit details of the most recent three months of income and expenses for the business. Adequate information must be made available to determine eligibility for the program. Self-declaration of income may be used. Consumers who are unable to provide written verification may provide a signed statement of income. 

7. Discounts: Those with an income at or below 100% of poverty will receive a full 100% discount for healthcare services. Those with incomes above 100% of poverty, but at or below 200% of poverty, will be charged a nominal fee 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 Line Guidelines. 

8. Nominal Fee: Consumers with incomes above 100% of poverty, but at or below 200% poverty will be charged a nominal fee according to the attached sliding fee schedule and based on their family size and income. Consumers will not be denied services due to an inability to pay. The nominal fee is not a threshold for receiving care and is not a minimum fee or co-payment. 

9. Waiving of Charges: In certain circumstances consumers may not be able to pay the nominal or discount fee. Waiving of Charges must be approved by Renew Counseling, Consulting, and Wellness Service’s designated official. Any waiving of charges should be documented in the consumer’s file along with an explanation. 

10. Applicant notification: The Consumer Sliding Fee Discount Program determination will be provided to the applicant(s) in writing and will include the percentage of the Consumer Sliding Fee Discount Program write off, or, if applicable, the reason for denial. If the application is approved for less than a 100% discount or denied, Renew Counseling, Consulting, and Wellness Services will work with the consumer and/or responsible party to establish payment arrangements or to identify an alternative funding source. The Consumer Sliding Fee Discount Program applications covers outstanding consumer balances for six months prior to application date and any balances incurred within 12 months after the approved date unless their financial situation changes significantly. The consumer has the option to reapply after the 12 months have expired or anytime there has been a significant change in family income. When the consumer reapplies, the look back period will be the lesser of six months or the expiration of their last Consumer Sliding Fee Discount Program application. 

11. Refusal to pay: If a consumer verbally expresses an unwillingness to pay or vacates the premises without paying for services, the consumer will be contacted in writing about their payment obligations. If the consumer is not on the sliding fee schedule, a copy of the Consumer Sliding Fee Discount Program application will be sent with the notice. If the consumer does not try to pay or fails to respond in 30 business days, this constitutes refusal to pay. Renew Counseling, Counseling, and Wellness Services can explore options not limited to offering a consumer payment plan, waiving of charges, or referring the consumer to collections if applicable. 

12. Record keeping: Information related to the Consumer Sliding Fee Discount Program decisions will be maintained and preserved in a centralized confidential file located in the business office manager’s office, to preserve the dignity of those receiving free or discounted services. 

• Applicants that have been approved for the Consumer Sliding Fee Discount Program will be logged in Renew Counseling, Consulting, and Wellness Services practice management system, noting names of applicants, dates of coverage and percentage of coverage. 
• The business office manager will maintain an additional monthly log identifying Consumer Sliding Fee Discount Program recipients and dollar amounts. Denials and applications not returned will also be documented.

13. Policy and procedure review: The Consumer Sliding Fee Discount Program will be updated based on the current Federal Poverty Guidelines. Renew Counseling, Consulting, and Wellness Services will also review possible changes in its policy and procedure and will examine business practices which may serve as barriers preventing eligible consumers from having access to community care provisions. 

14. Budget: During the annual budget process, and estimated amount of Consumer Sliding Fee Discount Program services will be placed into the budget as a deduction from revenue.