Thanks so much for your question. The HRSA Compliance Manual ( Chapter 9-Sliding Fee Discount Program) “Other Considerations” (pg. 41), states that “The health center determines how and with what frequency to reassess patient eligibility for the SFDS”. The frequency should be included in the board approved sliding fee discount policy. While a health center can opt to do them every 2-3 years there are some significant considerations to remember.

1. The federal poverty guidelines must be updated every year and approved by the board. If a health center doesn’t assess patient eligibility on a yearly basis, a patient could actually be in the wrong level/class within the sliding fee discount program. This means a patient may be paying too much or too little based on the wrong sliding fee class.

2. A patient’s situation may change in a year. By waiting to assess family size and income every two or three years, a health center may be actually causing a burden on a patient by not assessing their income and family size. What if a patient’s situation changes and the patient forgets to tell the health center? Again, they may be assessed incorrectly.

HRSA leaves the frequency decision up to the health center; but remember, the HRSA Program Requirements are the floor not the ceiling. In keeping this in mind, a health center would want to consider all outcomes and patient affects in determining the frequency of collecting this data.