What is a Sliding Scale, and what are the policies???

The purpose of this policy is to ensure that individuals are not denied access to services due to inability to pay. The Agency offers a sliding fee scale as part of its charitable mission to reduce financial barriers while maintaining fairness, consistency, and financial sustainability.

ESP Wellness uses the most current HHS Federal Poverty Guidelines for the 48 contiguous states and the District of Columbia. The sliding fee schedule is reviewed and updated at least annually after publication of new guidelines. 

Patients with family income at or below 100% of FPG receive a full 100% discount and have a patient responsibility of $0 for covered services. ESP Wellness does not impose a nominal charge on patients at or below 100% FPG. Patients above 100% and at or below 200% FPG pay the reduced amount established by the sliding fee schedule. No patient will be denied services because the patient cannot pay the discounted amount at the time of service.

A request for discounted services may be initiated by the patient, responsible party, family member, staff member, or another person aware of financial hardship. The patient/responsible party must complete the SFDP application. Staff will assist with completion when needed and will protect the dignity and confidentiality of applicants.

Applicants must provide enough information for ESP Wellness to determine family size and income. Acceptable verification may include one or more of the following: prior-year tax return or W-2; two recent pay stubs; employer letter; Social Security, disability, pension, unemployment, or veterans benefit statement; self-employment income and expense records; or other reliable documentation. 

When written documentation is unavailable, a signed self-declaration/self-attestation of income may be accepted. Lack of standard documentation alone will not automatically disqualify an otherwise eligible applicant.

SFDP applications, verification documents, eligibility decisions, effective dates, discount levels, and related account adjustments will be maintained confidentially. Access is limited to staff with a legitimate business or clinical need. ESP Wellness will maintain sufficient records to demonstrate consistent application of the program during audits or NHSC review.

The designated administrator is responsible for implementation of this policy, staff education, annual review of the FPG table, updating the sliding fee schedule, monitoring patient notices, and reviewing institutional practices that may create barriers to access. The policy and supporting materials will be reviewed at least annually and revised as needed.

The designated administrator or designee will review each completed application, determine the applicable FPG percentage and discount level, and document the decision. The applicant will receive written notice of approval, discount level, effective period, or reason for denial. Eligibility decisions will be retained confidentially in the patient or business record. 

SFDP eligibility will be re-evaluated at least every 12 months. Patients may reapply sooner whenever there is a significant change in household income or family size. ESP Wellness may request updated information when needed to confirm continued eligibility.

For SFDP purposes, family size means the number of persons living in the household whose income and support are considered together. This includes the applicant and may include a spouse, dependent children, and other household members who are financially supported by or financially support the household. Related and non-related household members may be counted when they function as one economic household. The same definition will be applied consistently to all applicants.

Income means gross income before taxes from household members whose income is included in the family unit. Countable income may include: 

Gross wages, salaries, tips, commissions, and bonuses. 

Business and self-employment income after ordinary business expenses. 

Unemployment compensation and workers' compensation. 

Social Security, Supplemental Security Income, veterans benefits, survivor benefits, pension, and 

retirement income. 

Interest, dividends, royalties, rental income, estates, and trusts. 

Alimony, child support, regular financial assistance from outside the household, and other recurring 

income. 

Non-cash benefits are not counted as income. ESP Wellness will apply its income definition consistently and will not use assets as an eligibility factor.

This policy applies to all self-pay clients and underinsured clients receiving services from the Agency. Insurance-covered services are billed according to payer contracts and are not subject to the sliding fee scale unless permitted by law and payer guidelines.

This policy applies to patients receiving eligible outpatient behavioral health services from ESP Wellness Training & Supervision and to all residents of the Health Professional Shortage Area(s) served by the site. The program is available to uninsured and underinsured patients and is not conditioned on applying for insurance or public benefits. 

• Sliding fee determinations are made by authorized administrative or clinical leadership staff.
  
  

• Individual clinicians may not independently alter fees outside this policy.
  
  

Any exception to the sliding fee scale must be documented with justification and supervisory approval.

The following must be documented in the client record:

• Household income and household size (self-reported or verified)
  
  

• Sliding fee determination
  
  

• Approved fee amount
  
  

• Date of determination
  
  

• Review or reassessment date
  
  

All documentation is maintained in accordance with HIPAA and confidentiality standards.

• Sliding fee eligibility is reviewed at least annually or sooner if the client reports a change in financial circumstances.
  
  

• Clients are responsible for notifying the Agency of changes that may affect eligibility.
  
  

Sliding fee determinations are made without regard to race, color, religion, gender identity, sexual orientation, age, disability, national origin, or any other protected characteristic.

• The Board of Directors approves the sliding fee scale structure and policy.
  
  

• The Board does not review or approve individual client fee determinations.
  
  

This policy is reviewed periodically to ensure compliance with regulatory and funding requirements.

This policy supports the Agency’s charitable purpose by promoting equitable access to care and avoiding private benefit, in compliance with IRS regulations governing 501(c)(3) organizations.

ESP Wellness will notify patients of the Sliding Fee Discount Program through multiple methods, including: 

• 

Prominently posted signage in the reception/waiting area or another common patient area. 

An online statement on the organization's official website and, when applicable, social media. Information provided during intake, registration, and financial discussions. 

Availability of the SFDP application and assistance completing it upon request. 

English and Spanish notice language, and additional translations when appropriate for the patient population. 

Required notice: No one will be denied access to services due to inability to pay. There is a discounted/sliding fee schedule available based on family size and income.

ESP Wellness will make reasonable efforts to secure payment according to the approved sliding fee schedule and from applicable third-party payers. When a patient is unable to pay, staff may offer a reasonable payment arrangement or consider an approved waiver based on documented hardship. Collection activity will not be used to deny clinically appropriate services solely because of inability to pay. 

A patient who is unwilling to pay despite having the ability to do so may be contacted regarding the balance and offered payment arrangements. Before external collection action is considered, ESP Wellness will review the account for SFDP eligibility and documented hardship. Any waiver or adjustment outside the standard schedule must be approved by the designated administrator and documented.