Policy Statement

HOME is committed to making mental health services accessible to all individuals, regardless of their financial status. This Sliding Fee Discount Program is designed to provide reduced-cost or free services to individuals and families who are uninsured, underinsured, or otherwise unable to pay for services. No individual will be denied access to services due to inability to pay.

Purpose

The purpose of this policy is to outline the eligibility criteria, application process, and administrative procedures for the Sliding Fee Discount Program at HOME. The program ensures equitable access to care while maintaining financial accountability and compliance with nonprofit standards.

Eligibility Criteria

• Eligibility is based solely on household income and family size.
  
• HOME uses the most current Federal Poverty Guidelines (FPG) to determine eligibility.
  
• Discounts are offered on a sliding scale for those with incomes between 100%–200% of the FPG.
  
• Individuals with income at or below 100% of the FPG are eligible for a full discount, with a nominal fee of $10 per visit (waivable in special cases).
  
• No discrimination will be made based on race, color, national origin, sex, disability, religion, age, sexual orientation, or gender identity.
  

Procedure Overview

1. Patient Notification
   HOME informs all clients of the Sliding Fee Discount Program by:
   
   • Providing brochures at intake and front desk
     
   • Offering information during assessment
     
   • Posting signage in the waiting area
     
   • Including the application on the HOME website and with any billing notices
     
2. Application Process
   
   • Patients may request the application through staff or the website.
     
   • Applications must be completed in full and signed by the applicant.
     
   • Proof of income must be submitted, including (but not limited to):
     
     • Prior year W-2
       
     • Two recent pay stubs
       
     • Employer letter
       
     • Form 4506-T for tax transcript
       
   • Self-declaration is only permitted under special conditions (e.g., homelessness) and must be accompanied by a written statement.
     
3. Review & Approval
   
   • Front Desk or designated administrative staff will assist with the application process.
     
   • Applications are reviewed confidentially.
     
   • Notification of approval or denial will be sent in writing and include the determined discount level.
     
   • Approved discounts are valid for 12 months and may retroactively apply to 6 months prior to the approval date.
     
4. Confidentiality & Record-Keeping
   
   • All applications and determinations are stored securely and confidentially.
     
   • Approved applicants are logged in a password-protected document maintained by the Office Manager.
     
   • Monthly logs will track the number of recipients and total amounts discounted.
     
5. Denials & Appeals
   
   • Applicants denied a discount will be informed of the reason and may reapply with updated documentation.
     
   • Appeals or requests for charge waivers due to hardship must be reviewed and approved by designated HOME staff.
     
6. Program Review & Budgeting
   
   • The Sliding Fee Discount Program is reviewed annually and updated in alignment with new Federal Poverty Guidelines.
     
   • Budget allocations for the program will be proposed annually and approved by the Board of Directors.
     

Key Definitions

• Family: Two or more individuals related by birth, marriage, or adoption, residing together.
• Income: Includes wages, unemployment benefits, Social Security, alimony, child support, and other financial resources. Non-cash benefits like food stamps are excluded.