Chapter 9, Element L (Evaluation of the Sliding Fee Discount Program) requires that the health center evaluates the effectiveness of the program in reducing the financial barriers to care, and completes this at least once every three (3) years . While it’s the health center’s decision on the method of evaluation of the sliding fee discount program, there are a few best practices which may be implemented. 

One best practice is to query data from each of the pay classes within the sliding fee discount program, then survey those patients to ask whether their pay class was a barrier to accessing care, or if the cost of their care is a hindrance to return to receive services. After data is collected, share the data. Talk about it in your senior team meetings, share it as part of the Quality Improvement Program, and most importantly, share the data with the governing board of directors. Ensure that the discussion is documented in the Board of Directors meeting minutes. 

Remember, the Sliding Fee Discount Program or your Sliding Fee doesn’t have to change based on the data; just make sure that your health center is evaluating the program to ensure patients are able to receive care. Also, if you have more than one Sliding Fee Scale (Medical, Dental, Behavioral Health, Pharmacy etc.), please make sure that you’re also evaluating those in the same manner. The National Association of Community Health Centers (NACHC) just released a module (YR: 2022) entitled “Tips for Health Center Boards to Evaluate the Sliding Fee Discount Program” which can be found here: https://conferences.nachc.org/nachc/articles/5213/view.