Process for Implementing the Federal Poverty Guidelines

One of the things that defines Community Health Centers (CHCs) is the process of seeing patients regardless of their ability to pay. CHCs must provide a full discount to individuals and families with annual incomes at or below 100% of the Federal Poverty Guidelines (FPG), except for nominal fees which may be collected, and no one who falls over 200% FPG is eligible to receive discounted services. The determination of the discount available to our patients must be based on family size and income, and nothing else. While CHCs have some flexibility in determining the amount of the discount, the basis for that determination of the level is based on the FPG that is published annually in the Federal Register. This is typically published in January and CHCs must have a process in place to implement this scale as quickly as possible.

In order to achieve this, the following steps are suggested:

1. Assign a specific staff member to monitor the federal register beginning in January of each year.
2. Once the FPG is published, update all sliding fee scales within the health center. CHCs are allowed to have multiple scales based on service type, so you could potentially have many scales to update.
3. It is important to ensure that all published scales are completely accurate, so having a second person review the scale(s) would be beneficial. 
4. Present the new scales to the Board of Directors for approval and document the approval and any discussion in the minutes. 
5. Once approved, CHCs must have a process in place for updating the new scale in the practice management system. An individual within the CHC should be assigned this task to ensure that all scales are updated appropriately. 
6. All staff should be made aware of the effective date of the updated scale so that potential issues can be identified quickly.
7. All printed materials must be updated, including brochures, posted information, handouts, etc. If the scale is published on the web site, make sure this information is updated.
8. It is important to ensure that all information posted at your sites concerning the availability of the sliding fee scale applies uniformly to ALL patients. If the scale is normally posted at your locations be sure to update those.

In order to achieve compliance and provide services to all patients, regardless of their ability to pay, in an effective, efficient manner, it is imperative that the FPG be updated in a timely manner, when published.

2024 Annual Update of the HHS Poverty Guidelines