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Subject: Client
and Fee
Effective: Supersedes: Revised:
Author: Approved by:
Goal: The
Department will provide high quality and affordable health care and public
health services. All clients
will be treated equally and in a consistent manner, regardless of ability
to pay or service being received. In all instances, the client's confidentiality
and safety will be considered. The
following Financial Guidelines are established in support of the above and
apply to onsite and health mobile services (except where specified).
They do not apply to special clinics. I.
Fee
Setting: A.
Personal Health Service fees are calculated and reviewed annually,
and are based on the DSHS Medicaid reimbursement rate.
In the event a change is necessary at another time during the year,
a Fee Change Request Form (Attachment B) must be completed and reviewed by
the Personal Health Management Team. B.
Fees for medication and supplies will be actual costs rounded to
the next dollar. C.
Fees for outside laboratory and xray services will be based on the
contracted rates paid to outside labs for their services. D.
Fees for special clinics will be set according to costs of vaccine,
supplies, and staff; and will be applied without fee assessments. II.
Charges
for Services: A.
All clients, who are not excluded by the program requirements,
shall pay fees based upon the sliding fee scale. B.
Charges will be determined on a sliding fee scale.
This sliding fee scale is based on Federal Poverty Guidelines and
will be updated annually. The
sliding fee schedule used will set the minimum pay category at 0-100% and
full pay at 251% of the Federal Poverty Guidelines, offering up to a 100%
discount. C.
An office visit will be charged for all
services except WIC and Non-Routine Service Provision as described in
Section VIII. D.
No
one will be refused service due to the inability to pay. III.
Fee
Assessments: A.
Fee Assessments will be conducted during the client
registration/check in process. B.
Fee Assessments will generally be conducted every six months or
when requested by the client or deemed necessary by staff. C.
A uniform method of financial screening will determine the client's
ability to pay using a confidential income assessment form. D.
The client's ability to pay for services received is based upon
gross monthly income and the number of persons in the family. E.
The following clients are not eligible for discount: 1.
Clients who refuse to provide income and family size information. 2.
Clients who have received insurance payments for services rendered
and have not made payment to the health department. 3.
Clients, 19 years and older, who refuse to permit billing to third
party resources or refuse to sign the HCFA 1500 (standard billing claim
form) release of information and assignment of benefits statements. 4.
Clients who are at or above 251% of the poverty level. 5.
Clients, who have health insurance that covers, and will pay for,
services rendered. 6.
Federal guidelines require sponsors of new immigrants, and
immigrants changing status, to cover needs of individuals they sponsor.
Sponsors will be advised they are expected to pay costs of
services. IV.
Assessment
Guidelines: A.
Family Planning/STD Clinics 1.
All requirements in the Washington State Department of
Health/Family Planning Program Policy 4500 on Client Fees, Billing, and
Collection will be followed for all Family Planning clients. 2.
Adolescent Clients (18 Years and Under): a.
Any client 18 years and under is considered an adolescent and may
be assessed either as a member of their family or as a separate family. b.
If the client does not live with a parent or is otherwise
self-supporting, they should be assessed as an adult. c.
If a parent supports the client, and the parent is willing to pay
for the visit, the client should be assessed as a member of the parent's
family and the family's income should be used to determine the fee
category. d.
If a client's confidentiality could be violated by the requirement
to produce information regarding family income, the Health Department will
assess the client's ability to pay as follows: i.
The client will be considered a family of "one." ii.
Add personal income from allowance or employment.
Income is based solely on the disposable income available to the
client. (Do not use income
from a partner, parent, aunt, uncle or friend) to compute total family
income. 3.
Adult Clients (19 Years and Older): a.
Use the client's income and family size to determine the fee
category. b.
A married couple is one family. c.
A single adult living alone,
or with a person or persons not related by marriage, is a separate family. d.
An adult child living with
parents is a separate family. B.
Immunization Clinic 1.
Adolescent Clients (Under 18 Years of Age) a.
Family income and size will be used to determine appropriate fee
category. b.
See below for Hepatitis A and B Immunizations. 2.
Adult Clients (19 years and Older): a.
If the client is supported by a parent, (the parent provides more
than 50% of the clients' living expenses), and/or the parent is
responsible for the client's medical care, the client will be assessed as
a member of the parent's family. a.
If the client does not live with a parent or is otherwise self
supporting, the client's income and family size will be used to determine
the fee category. A.
Hepatitis A and B Immunizations When
Hepatitis A or B immunizations are administered to adolescents (Under 18)
through the Family Planning or STD Clinics, the financial guidelines of
those clinics will be observed. This
applies when they complete the immunization series through the regular
Immunization Clinic. V.
Payment: A.
Payment upon receipt of services is expected.
If the client cannot pay for services on the date received, a bill
will be sent to the client with payment expected in 30 days from the date
of service. Payment
arrangements can be made in advance during the fee assessment process or
by contacting the patient accounting staff. B.
Statements of outstanding balances are mailed on a monthly basis
requesting payment. In the
case of clients who do not wish to have statements sent to their
residence, for reasons of confidentiality, it is the responsibility of the
client to make regular payments. C.
Employer paid services will be provided at the full fee for service
and be billed to the employer. D.
If, because of anticipated non-payment by a third party payer
and/or inability of a client to pay for services, the client is reluctant,
postpones, or chooses not to receive services, a referral will be made to
a supervisor. The supervisor
will evaluate the need for services, how it fits within our public health
mission, and work with the client on alternatives and options. I.
Medical Coupons/Medicare (DSHS) A.
DSHS Medical coupons are accepted for all covered services. B.
Clients will be expected to provide a medical coupon or Medicare
card at the time of service. If
a medical coupon is not provided, the client will be billed as a private
pay client at full fee until the information is provided. C.
As required by WAC 388-87-010(6) and section 1862(a)(1) of the
Medicare law, an Informed Consent (Agreement to Pay) form must be
completed when providing a non covered service or item to a Medical
Assistance or Medicare client. This signed consent form, specifying non-covered services
provided, allows the Department to bill the client for services rendered
that are not covered by their Medical Coupons/Medicare. Without a signed form, the client will not be billed for non-DSHS
covered services. II.
Employer Based and Other Non-Routine Service Provision A.
Employer Based Offsite Clinic In
place of an office call charge, a nursing time hourly rate will be charged
in addition to the fee for the service.
Nursing time charge will be evaluated based on public health
interest. B.
Employer Paid in-house Services 1.
Non-County employer paid adult immunizations are referred to other
community providers. Exception:
Animal Services, local police and local fire districts. 2.
Animal Services - Due to public health interest, rabies vaccine
will be administered to employees of Animal Services at the cost of the
vaccine only. C.
County Departments 1.
Office call charge will be waived to County Departments for
immunization related services to County employees when required for County
employment. 2.
County employees seeking immunization-related services, not
required for County employment, will be treated as any other client
seeking services. D.
Individual Based Special Clinics (i.e., MMR Clinics) The
Personal Health Management Team prior to scheduling special clinics will
determine charges for services. E.
Direct Observed Therapy One
office visit charge will be assessed per month regardless of the number of
visits. IX.
Referrals
for Outside Services/Prescription Medications A.
Outside Services 1.
When clients who have a third party payer are referred to an
outside service (such as xray or lab), the outside service will be
instructed to bill that third party payer.
The client will not be billed on the Health Department superbill
for that service. 2.
When clients who do not have a third party payer are referred for
chest x-rays to rule out active tuberculosis, the xray provider will be
instructed to bill the Health Department for services.
The client will be billed on the Health Department superbill for
the chest xray and the sliding fee scale will be applied (unless the
client is a sponsored immigrant-see Section III.E.6). B.
Prescription Medications (Oral contraceptives are excluded) 1.
When clients who have a third party payer require prescribed
medications, those medications will be obtained from a pharmacy under
Health Department staff's prescriptive authority, unless it is determined
that obtaining the medications from a pharmacy will pose a barrier to that
client obtaining the medications. In addition, if a client has HMO or PPO insurance that only
reimburses for those medications prescribed by the client's primary care
provider; nursing staff or the Health Officer will request that the
primary care provider prescribe the medication and the medication will be
obtained at a pharmacy. In
these cases, the pharmacy will bill the client's third party payer and the
client will not be billed for the medications on the Health Department
superbill. 2.
When clients who do not have a third party payer require prescribed
medications, the Health Department will dispense the medications.
The client will be billed on the Health Department superbill for
the medication and the sliding fee scale will be applied. X.
Exceptions
Attachment B FEE CHANGE REQUEST Date_______________ REQUEST
THAT CURRENT FEE FOR SERVICES BE CHANGED. Program/Description of Service
Current Fee
New Fee ________________________ Reviewed
by Management Team on: _________________Initials_______________
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