According to the U.S. Department of Health and Human Services Federal Poverty Guidelines, the ability of an individual to pay is determined by his annual income and the size of his family. Institutions offering sliding fees should develop a policy and procedure to determine eligibility for patient discounts. They may use a patient's tax forms from the most recent year, paycheck stubs for one month or a fixed income statement. If a patient is self-employed, tax forms from current year and a profit-and-loss statement are required. All family income is to be included, before taxes are deducted.
Federally Qualified Health Care Centers are required to prepare a schedule of fees or payments for the provision of services. The schedule should be consistent with the local prevailing charges. The fee scale can also be designed to cover the costs of operation for the health center. Fee schedules vary from one state to another depending on the average income of people being targeted by the health center.
Qualified institutions are required to prepare a schedule of discounts to be applied to the payment of service fees. The discounts are adjusted on the basis of the patient's ability to pay. Health centers must avail the discount schedule to all individuals and families with an annual income below 200 percent of the poverty guidelines. Individuals and families receive a full 100 percent discount if they have an annual income below 100 percent of the poverty guidelines. The center is allowed to charge a nominal fee for its operations.
Health centers are required to obtain reimbursement from third-party payers such as Medicaid, Children's Health Insurance Program (CHIP), Medicare and any public assistance program in which a patient is enrolled. These programs pay a certain amount of money to the health center on behalf of the patient. The third-party payers do not qualify for the schedule discount and they are charged on the basis of the full amount of fees and payments of services received by the patient.