It can be difficult to get all the required language in either a Contract (Column II) or MOU for Column III services. With the update of the Site Visit Protocol in May 2022, there are a couple of things that a health center can do. First, talk with the referral agency.

In some instances, having an open and honest conversation with referral agencies to explain the requirements that health centers are under to be in compliance with the program requirements may help. Provide them with the Compliance Manual and/or Site Visit Protocol. Second, if a health center is unable to ensure the sliding fee discount is within the MOU, a health center can also keep the referral agency’s charity care policy or actual sliding fee on hand and attach it with the MOU when it comes time for the Operational Site Visit (OSV).

As an example, at times, charity care policies offered by a hospital are better than what a health center may offer. Sliding Fee information can sometimes be found on an agency’s website or other informational areas. It never hurts for a health center to ask for the organization’s sliding fee policy.

Remember, services that are not billed for the local health care market do not have to have the sliding fee language within the MOUs. These include, but are not limited to, transportation, translation, or other non-clinical services. Third, keep all documentation between the health center and the referral agency.

Any emails, phone calls, formal communication etc. can be kept, demonstrating that the health center attempted to ensure that services under Column III included the sliding fee provision. Provide this documentation to the HRSA Point of Contact. While this does not guarantee compliance with Element J in Chapter 19 (Sliding Fee Discount Program), documentation may help the HRSA Point of Contact determine how best to help and guide a health center.  Lastly, ask other colleagues within the health center community to see if there are any best practices they can share. Working together within the health center community can provide operational excellence support.

For more information, please visit: https://bphc.hrsa.gov/compliance/site-visits/site-visit-protocol/sliding-fee-discount-program.