Effective April 1, 2017
Purpose: In compliance with the requirements for implementation of a Certified Community Behavioral Health Clinic, the policy outlines our approach to offering clients fees on a sliding scale.
Policy: It is the policy of LifeWorks NW CCBHC Beaverton, Hillsboro-Walnut, King and Gresham sites to provide appropriate care to all those who need care. No individuals will be denied behavioral health care services (mental health and addiction), including but not limited to crisis management services, because of an inability to pay for such services. The staff of LifeWorks NW CCBHC will work with clients to ascertain the most fiscally viable means of supporting their care. Fees will be determined based upon family size and number of persons in the household.
LifeWorks NW CCBHC is committed to the principle that clients should know the cost of services they are requesting and the out-of-pocket expense that will be expected of them PRIOR TO THE DELIVERY OF THOSE SERVICES. Other than in crisis situation, it is the intent of LifeWorks NW CCBHC to, as best possible, determine the per-session, out-of-pocket expense for each client.
Other than in crisis situations, all clients will be provided a financial responsibility form (FRF) prior to start of their first session. The FRF will include a rate sheet with specifics indicating the per-session cost based on the clients financial eligibility. Clients will be assisted to complete the form.
OREGON HEALTH PLAN (OHP) CLIENTS: Clients who are eligible for OHP are fully covered at no cost to the individual unless their OHP plan requires a co-pay.
SLIDING FEE: Clients who are uninsured or underinsured have access to a sliding fee discount schedule (SFS). This schedule will also be posted in all LifeWorks NW CCBHC waiting rooms. Language regarding the sliding fee schedule shall be communicated in languages/formats appropriate for individuals seeking services who may have language barriers or disabilities. The sliding fee schedule will be based on Portland metro area prevailing rates (usual and customary), and include reasonable administration fees.
The SFS is intended to minimize financial barriers to care for clients at or below 250 percent of the current Federal Poverty Guidelines (FPG). Fees are based upon family income and the number of people in the household. Based upon where they fall on the SFS, clients will be responsible for a set percentage of the usual and customary rate established by the LifeWorks NW CCBHC. The usual and customary rate is set based on the LifeWorks NW CCBHC cost studies. Fees required by the CCBHC clinics may be reduced or waived if it is determined that there is an inability to pay.
LifeWorks NW CCBHC requires payment at time of service. If a client is unable to pay at time of service, then the client will be billed and attempts will be made to collect. LifeWorks NW CCBHC staff will work with clients in arrears and attempts will be made to help them meet their obligations. Good faith effort on the part of the clients will be honored. No interest is charged on accounts in arrears. Clients who are behind in payments or refuse to pay shall be addressed by their clinician and/or fiscal manager.
DETERMINING ELIGIBIITY: LifeWorks NW CCBHC staff will assist clients in determining whether they are eligible for sliding fee discounts. In an effort to reduce barriers to care, staff will ensure that the eligibility determination process is conducted in an efficient, respectful, and culturally appropriate manner. Client privacy and confidentiality will be protected throughout the process.
The following documents will be accepted for determining sliding fee eligibility:
- Income tax returns
- Two most recent pay stubs
- Signed letter(s) from employers documenting earnings
- Documentation of disability payments or unemployment benefits
While scheduling their first appointment, clients will be asked for information to help determine their eligibility for SFS. If eligible, they will be asked to bring accepted documentation to their first session. We will assist SFS clients in applying for OHP and other supports, if available. LifeWorks NW CCBHC adheres to state and federal rules regarding pursuit of third party, Medicaid and Medicare payments.
SFS eligibility will be reviewed at least annually, or if client circumstances change.
WAIVING FEES: No individuals will be denied behavioral health care services including but not limited to: crisis management services or an inability to pay for such services. The CCBHC Practice Manager has authority to waive or lower the cost of services, if warranted.
UNINSURED OR UNDER-INSURED: The SFS may serve clients with third party insurance when that insurance does not cover or only partially covers fees for services. These clients must also be eligible for the SFS based on income and family size. In such cases, the client will be responsible for the lesser of their insurance copay/deductible or their assigned their SFS fee amount.
PRIVATE INSURANCE: If the client with insurance meets eligibility for SFS, reduced fees may be available using the SFS. LWNW CCBHC will document all co-pays and deductibles, as well as any need for prior authorization, and ensure that the client understands what their responsibility might be.
PRIVATE PAY: Clients who are not on OHP or who do not have insurance coverage are considered to be “Private Pay.” If they are not eligible for the SFS program, they will be required to pay the full fee based upon the established usual and customary rates. If the client feels there are mitigating circumstances they may appeal this rate and ask for a reduced rate. There are no guarantees that further accommodations will be made.
OTHER CIRCUMSTANCES: Situations where fees are determined by other agencies will be dealt with on a case by case basis (ex. Federal Parole & Probation) may require a co-pay).
FEE COLLECTION: LWNW CCBHC commits itself to:
- Being clear about the client’s responsibility.
- Billing clients in a timely manner so they understand their account balance.
- Responding in a timely manner to clients who are falling behind.
- Collecting payments at time of service as much as possible. However, clients will not be denied service if they are unable to pay at time of service.
Clinical staff will be aware of issues related to payment and be involved at a significant level in the resolution of the issue.
If a client becomes significantly in arrears due to failure to pay and fails to show a
“good faith” effort to resolve the situation, the account may be released to collections.
In some cases, accounts may be written off as uncollectable and will be deemed “charity” care.