Sliding Fee Discount Program Policy

Sunflower Counseling is pleased to offer a sliding scale and make available free or discounted services to those in need.

EFFECTIVE DATE: Original date January 1, 2021

Revision dates: January 1, 2022, January 1, 2023, April 1, 2024

POLICY: To provide access to counseling for all individuals, offering free or discounted service to those in financial need, including those uninsured and underinsured.

PURPOSE: Sunflower Counseling ensures that all clients seeking mental health services are served regardless of their ability to pay, whether payment for those services would be made under Medicare, Medicaid or CHIP. We are committed to ensuring no one is refused service due to financial constraints. We will base our program eligibility on family size and income, and will not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age sexual orientation or gender identity. The Federal Poverty Guidelines are used in creating an annually updating the sliding fee schedule to determine eligibility.

PROCEDURE: We will use the following guidelines in following the sliding fee discount program

As part of the intake process, all new clients will receive comprehensive information regarding our Sliding Fee Discount Program within their intake paperwork. This ensures that clients are informed about the availability of discounted services from the outset of their engagement with Sunflower Counseling.
Additionally, all current clients will receive an annual update on practice policies, which will include a review of the Sliding Fee Discount Program. This yearly communication serves to keep all clients informed of any changes and reaffirms our commitment to providing accessible counseling services.
Inclusion of the Sliding Fee Discount Program will be displayed on our website.
Sunflower Counseling places notification of Sliding Fee Discount Program in the waiting areas of each office location.

Request for Discount: Requests can be made by clients, family members, or social services staff. The program is applicable solely to counseling sessions. Forms and information are available by email request or completing a form.

Administration: The Sliding Fee Discount Program is administered under the direct supervision of our practice manager or designated office staff, who ensures compliance with our policy and the integrity of the application process.

Our dedicated staff will provide each client with the necessary information about the program’s policies and procedures, upholding the utmost respect for privacy and dignity.
Discount Program application to facilitate a smooth and respectful process.
Confidentiality is paramount, and we are committed to maintaining discretion in all interactions related to the Sliding Fee Discount Program.

Application Completion: The client or responsible party must fully complete the application. Assistance will be provided as needed. Signing the application confirms income disclosure to Sunflower Counseling.

Eligibility: Discounts are determined based on income and family size, with no discrimination on any basis. Definitions of family and income mirror those in the provided sample, including a comprehensive list of income sources:

Family Definition: For the purposes of the Sliding Fee Discount Program at Sunflower Counseling, a family is defined as a group of two or more individuals, one of whom is the head of the household, who are related by birth, marriage, or adoption and reside together. This encompasses all individuals within the household, including those related by subfamily connections. In our commitment to inclusivity, Sunflower Counseling also recognizes non-related individuals living within the same household as part of the family unit for the purpose of determining family size.
Income Consideration: Income, as considered for the Sliding Fee Discount Program, encompasses all monetary resources available to the family. This includes, but is not limited to, gross wages, salaries, tips, earnings from businesses, self-employment, unemployment and workers’ compensation, Social Security benefits, Supplemental Security Income, veterans’ payments, survivor benefits, pensions, retirement income, and revenue from investments such as interest, dividends, royalties, rental properties, estates, and trusts. Additionally, regular support such as alimony, child support, and any assistance received from outside the household fall under this definition. Other miscellaneous sources of income will also be considered.

Income Verification for Sliding Fee Discount Program: To assess eligibility for the Sliding Fee Discount Program, Sunflower Counseling requires that applicants provide proof of income. Acceptable documentation includes any of the following:

The previous year’s W-2 form.
The two most recent pay stubs.
A letter from the current employer verifying income.
Form 4506-T for those who have not filed a W-2.
Individuals who are self-employed must present a detailed account of their business’s income and expenses for the most recent quarter. It is essential that sufficient information is provided to accurately assess eligibility for the discount program.
Self-declaration of income may also be used.

In situations where standard written verification cannot be produced, applicants may submit a signed statement of income. This declaration should explain the applicant’s financial situation and the reason why traditional documentation is unavailable. Sunflower Counseling will review these statements on a case-by-case basis to determine program eligibility.

Sliding Fee Discount Program – Discount Structure: At Sunflower Counseling, the discount applied to our counseling services is directly correlated with the client’s income in relation to the Federal Poverty Guidelines:

Clients with a household income at or below 100% of the Federal Poverty Guidelines will be eligible for a full discount, amounting to 100% off the cost of counseling services provided by Sunflower Counseling.
To ensure relevance and fairness, the Sliding Fee Schedule is reviewed and updated annually during the first quarter of the year to align with the most current Federal Poverty Guidelines.

Waiver of Fees: Sunflower Counseling recognizes that some clients may face circumstances that prevent them from paying the discounted fee. In such cases, a waiver of fees may be granted. The authority to approve a fee waiver lies with a designated official within Sunflower Counseling. Each waiver must be accompanied by thorough documentation, which will be securely filed in the client’s records with a detailed explanation for the waiver. This ensures that all decisions regarding fee waivers are transparent, equitable, and preserve the integrity of our Sliding Fee Discount Program.

Definitions:

Uninsured: Individuals with no private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program, state-sponsored, other government, or military health insurance coverage.

Underinsured: Individuals with public or private insurance policies that do not cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability to pay.

Applicant Notification: Upon evaluation, Sunflower Counseling will provide applicants with a written notification of the Sliding Fee Discount Program determination. This communication will detail the approved discount percentage or, if the application is not approved, the specific reasons for denial. Should the application be granted for less than a full (100%) discount or be denied, our staff is committed to collaborating with the client or their responsible party to create a manageable payment plan.

The Sliding Fee Discount Program benefits extend to cover any outstanding balances incurred by the client for six months prior to the application date as well as for services received within 12 months following the date of approval, provided there has been no significant change in the client’s financial circumstances. Clients are welcome to reapply once the 12-month period has lapsed or sooner if they experience a substantial change in their financial situation. For returning applicants, the period considered for financial assessment (‘look back’ period) will be either six months or the duration since the expiration of their previous Sliding Fee Discount Program application, whichever is shorter.

Addressing Payment Issues at Sunflower Counseling:

When a client at Sunflower Counseling either states an unwillingness to pay or leaves the facility without settling their bill, we will initiate contact in writing to remind them of their payment responsibilities. In such correspondences, if the client is not already benefiting from our Sliding Fee Discount Program, we will include an application for the program to provide them with an opportunity to apply for financial assistance.

Refusal to Pay

If there is no response or attempt to arrange payment within 60 days, it will be considered a refusal to fulfill payment obligations. While clients are not required to make future payments prior to receiving services, if they do not fulfill their payment obligations, their future sessions may be cancelled. In such cases, clients may be asked to pay their outstanding balance before resuming services. Sunflower Counseling may offer a structured payment plan to help resolve the situation.

Record Keeping: Confidential file maintenance procedures, including logging approved applicants and maintaining logs of recipients, denials, and unreturned applications.

Record Keeping and Confidentiality: Sunflower Counseling is dedicated to upholding the confidentiality and dignity of those we serve, particularly when it involves personal financial information. Accordingly, all documentation and information pertaining to decisions about the Sliding Fee Discount Program will be securely maintained in a HIPAA-compliant digital format. This approach ensures both the privacy of our clients and the integrity of our program.

Details of applicants who are approved for the Sliding Fee Discount Program will be securely entered into Sunflower Counseling’s electronic practice management system. This will include the names of applicants, the effective dates of their coverage, and the specific discount percentage awarded.
The office manager will oversee the maintenance of a monthly digital log, which will record the names of the recipients, the amount of discount applied, and a summary of denied applications or those that remain incomplete or unreturned.

Policy and Procedure Review: Sunflower Counseling will conduct an annual review of the Sliding Fee Schedule to ensure it aligns with the most recent Federal Poverty Guidelines. Additionally, we will periodically reassess our policies and procedures, including an examination of our institutional practices, to identify and dismantle any potential barriers that may impede eligible clients from accessing our sliding fee services.

Budget Considerations: In Sunflower Counseling’s annual budgeting process, a projected amount representing the Sliding Fee Discount Program services will be incorporated as a deduction from the anticipated revenue. This ensures financial planning is reflective of our commitment to making counseling services accessible to all segments of the community.

Services Covered Under the Financial Assistance Policy:

Our Financial Assistance Policy exclusively provides coverage for outpatient counseling services.

For more information, please contact our office at (406) 214-3810 or email us at hello@sunflowercounseling.com.