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H H S Department of Health and Human Services
Health Resources and Services Administration
Primary Care: The Health Center Program

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Sliding Fee Scale Requirements

Federally funded health centers and look-alikes must provide access to services without regard for a person's ability to pay. 

Health centers must

  • Prepare a schedule of fees or payments for the provision of services that is:
    • consistent with locally prevailing rates or charges and
    • designed to cover the reasonable costs of operation.
  • Make all reasonable effort to obtain reimbursement from third party payors — either public (Medicaid, CHIP, Medicare and any other public assistance program) or private health insurance (for patients who are eligible for coverage). These third party payors should be billed on the basis of the full amount of fees and payments for such services without application of any discount.
  • Prepare a corresponding schedule of discounts (or sliding fee scale) to be applied to the payment of such fees, in which discounts are adjusted on the basis of the patient's ability to pay.

In addition,

  • The health center's governing board must approve the fee schedule and schedule of discounts. The board should review and update the fee and discount schedule on a regular basis.
  • Health centers should post signs announcing the availability of discounts in a prominent and accessible location. Patients should be made aware of the discount option.

Ability to Pay

Ability to pay is determined by a patient's annual income and family size according to the most recent U.S. Department of Health & Human Services Federal Poverty Guidelines.

The schedule of discounts must:

  • Be made available for all individuals and families with an annual income below 200 percent of the poverty guidelines.
  • Provide for a full (100 percent) discount for all individuals and families with an annual income below 100 percent of the poverty guidelines.
  • Nominal fees may be collected from individual or families with an annual income at or below 100 percent of the poverty guidelines when imposition of such fees is consistent with project goals.