Sliding Fee Discount Policy

SLIDING FEE DISCOUNT POLICY

Policy: R&C Consulting Group, Inc. Sliding Fee Discount policy is designed to provide discounted care to those who have no means, or limited means, to pay for their mental health and substance abuse services.

R&C Consulting Group, Inc. will determine program eligibility on a person’s ability to pay and will not discriminate on the basis of age, gender, race, sexual orientation, creed, religion, or national origin. The Federal Poverty Guidelines are used in developing and updating the sliding fee schedule (SFS) to determine eligibility.

Discount Application Process and Guidelines 

1. Notification: R&C Consulting Group, Inc. will notify patients of the Sliding Fee Discount Policy as follows:
   • Notification of the Sliding Fee Discount Program in the waiting area.
   • Explanation of the Sliding Fee Discount Program and an application form are available on our R&C Consulting Group, Inc. website (www.rcconsultantgroup.com).
   • Notification of the Sliding Fee Discount Program will be offered to each patient upon admission.
2. Application: Sliding Fee Discount Applications are available at the R&C Consulting Group, Inc. Clinic or can be obtained by visiting our R&C Consulting Group, Inc. website. Patients requesting to receive a discount for services must complete the discount fee application (Attachment B) in full. Applications that are missing information and not signed by the patients are considered incomplete and the patient will not be eligible for the Sliding Fee Discount Program. The sliding fee scale is based on Family Size and Income only.
3. Family: Family is defined as a group of two or people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including subfamilies) are considered as members of one family. For instance, if an older married couple, their daughter and her husband and two children, and the older couple’s nephew all lived in the same house or apartment; they would all be considered members of a single-family.
4. Proof of Income: In addition to the application, all patients applying to receive discounted services must provide the Health Center with Proof of Income at the time the application is submitted or within five (5) business days from the date the application was submitted. Any patient who fails to provide proof of income will be responsible for the full charge of any services provided by R&C Consulting Group, Inc. A minimum of one form of income verification is required. Once approved, the discount will be honored for one (1) year. Any change in family size and income during the year will require the patient to reapply for the Sliding Fee Discount. Acceptable forms for proof of income include one of the following:
   • Last (current year) federal tax returns, quarterly tax statement if self‐employed.
   • The last 2 paycheck stubs for each adult working in the household.
   • A statement from your employer (signed, dated on company letterhead) stating rate of pay, average number of hours worked weekly, and hire date.
   • Unemployment benefit letter.
   • Social Security benefit letter showing your monthly payment (for each person receiving benefits).
   • Verification of Workers Compensation Insurance benefits.
   • Military family allotment verification.
   • Payment made from trusts or estates verification.
   • Documentation of child support (divorce papers, letter from Recovery Services)
   • Copy of pension/ retirement benefits.
   • Documentation of State support (letter of approval for food stamps or other benefits).
   • 1040 or W‐2 statement due to loss of employment.
   • Financial Support Document (Attachment D), only if a patient has no proof of income and relying on financial support of another individual or organization.
5. Record Keeping: The Sliding Fee Discount Program will be administered through R&C Consulting Group, Inc. Dignity and confidentiality will be respected for all who seek and/ or are provided discount services. All discounted applications will be compiled, scanned, and attached to the patient’s electronic medical records.
6. Discounts and Nominal Fees: Those with incomes at or below 100% of the Federal Poverty Level (FPL) will be responsible for a nominal fee. Patients eligible for the nominal fee (below 100% FPL) will be assessed a $20 nominal fee for mental health and substance abuse services for procedures that fall under Preventative Mental Health and Substance Abuse Services or Basic Mental Health and Substance Abuse Services. The list of procedures included in the nominal fee is in Attachment A. Non-covered procedures, although not included in the nominal fee, can be taken advantage of at a heavily discounted rate. Those with incomes above 100% of poverty, but at or below 200% of poverty, will be charged according to the approved annual sliding fee schedule (Attachment C). Patient access will be taken into consideration for each sliding fee discount including the nominal fee on an annual basis and will ensure that ability to pay does not create a barrier to care. R&C Consulting Group, Inc. will make reasonable efforts to secure and maximize payments from patients for services rendered. R&C Consulting Group, Inc. will conduct billing and collections from patients in an efficient, respectful, and culturally appropriate manner, assuring that procedures do not present a barrier to care, and patient privacy and confidentiality are protected throughout the process.

PATIENTS RECEIVING DISCOUNTS WILL NOT BE TURNED AWAY FOR INABILITY TO PAY. NO ONE IS REFUSED SERVICES BECAUSE OF LACK OF FINANCIAL MEANS TO PAY.

1. Alternate Payment Resources: All reasonable efforts to obtain reimbursement from third-party payers – either public (Medicaid, Medicare, Chip, etc.) or private health insurance(s) will be made. Third-party payers are billed on the basis of the full amount of fees and payments for such services without application of any discounts. R&C Consulting Group, Inc. has Outreach and Enrollment Specialists to help patients apply for these alternate resources.
2. Scope of Service included with this policy is: Behavioral Health- Mental health counseling and outpatient substance abuse counseling are covered under the discount fee program.

Covered Services
Attachment A

Sliding Fee Discount Application
Attachment B

Sliding Fee Discount Schedule
Attachment C

Financial Support Document
Attachment D

NOTICE TO PATIENTS
Attachment E