Evaluation of the
Sliding Fee Discount Program

Question: Hi! We have always been told that we have to evaluate the nominal fee to make sure that it doesn’t provide a barrier to patients. I was reading in the Compliance Manual that we may have to do something more. Do we just evaluate the nominal fee?

Thanks for the great question!! We get this question a lot! HRSA has provided some specific guidance around this type of question and you’re right! The health center needs to evaluate the entire Sliding Fee Discount Program.

You can find this information in the HRSA Health Center Program Site Visit Protocol, Sliding Fee Discount Program, Element L “Evaluation of the Sliding Fee Discount Program” or click on this link: Here. Based on the protocol and compliance manual, a health center should evaluate at least once every year the Sliding Fee Discount Program. In essence it’s the entire program (so not just the nominal fee but the entire pay classes within the sliding fee).

How the health center evaluates the program is up to the health center (remember there is no right or wrong way to do it; just that it gets completed). A health center can use patient satisfaction surveys, focus groups, and even include board members that are patients. The goal is to ensure that the Sliding Fee Discount Program is not a barrier to those that need care.

One example of analyzing data would be to query data from each of the pay classes within the sliding fee discount program and then based on the data, survey those patients to see whether that particular pay class was a barrier to their care or if the cost of their care is a hinderance to come back to receive care. 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 Director’s meeting minutes.

Remember, the Sliding Fee Discount Program or your Sliding Fee doesn’t have to change based on the data; just that the health center is ensuring that program is being evaluated 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.

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