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.

The Agency provides a sliding fee scale based on household income and household size in relation to the Federal Poverty Level (FPL). Fees are determined using objective criteria, applied consistently, documented in the client record, and reviewed periodically.

No individual shall be denied services based solely on inability to pay.

A client may be eligible for sliding fee consideration if they:

• Are uninsured or underinsured, or
  
  

• Experience financial hardship impacting their ability to pay standard fees
  
  

Eligibility is determined using:

• Self-reported gross household income
  
  

• Household size
  
  

• Current Federal Poverty Level guidelines
  
  

Income verification may be requested but is not required. Self-attestation is acceptable.

Fees are adjusted according to the following guidelines:

Household Income (% of FPL)

Client Fee

0–100%

$0–$25

101–150%

$30–$50

151–200%

$60–$80

201–250%

$90–$110

Over 250%

Standard Fee

• The Agency may establish a minimum fee of $0.
  
  

• The maximum discounted fee shall not exceed the Agency’s standard self-pay rate.
  
  

• 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 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.