L Primary Care Practitioner Loan Redemption Program
R
of New Jersey
Sliding Fee Scale Information Packet
P
Placement sites are eligible to apply for participation in the Primary Care Practitioner Loan Redemption
Program of New Jersey (NJLRP) and must have an established sliding fee scale. Health centers, private
practices, hospital based clinics, mobile clinics, homeless centers, school-based centers, correctional
facilities and other sites that provide primary outpatient care to underserved populations may qualify
to participate as an eligible site. This package includes materials that may be helpful to you in meeting
the NJLRP requirements which include:
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Using a discounted/sliding fee scale to ensure that no financial barriers to care exist for
those who meet certain financial eligibility criteria;
Indicate that no one who is unable to pay will be denied access to services;
Maintain a full-time clinical practice;
Providers work a minimum of 40 hours per week; and
Accept and participate with Medicare, Medicaid and Medicaid Managed Care programs
This package contains:
 An explanation of discounted/sliding fee scales; and
 Examples of discounted/sliding fee scales
The NJLRP suggests placement sites applying to participate in the program use the HHS Poverty Guidelines as
a guide to establish a sliding fee scale for your site. If one of the examples in this package fits the SFS for the
practice you may adopt the SFS and submit it to the NJLRP office with an effective date.
What is a discounted/sliding fee scale?
Discounted/sliding fee scales are a means of addressing the need for equitable charges for services
rendered to patients. A discounted/sliding fee scale is developed according to local fee standards and
must be in writing. Discounted/sliding fees are based upon federal poverty guidelines, and patient
eligibility is determined by annual income and family size. Sliding fee scales are established and
implemented to ensure that a non-discriminatory, uniform, and reasonable charge is consistently and
evenly applied. For patients whose household income and family size place them below poverty, a
typical, nominal fee is often between $7 and $15. Patients between 101-200% of poverty are expected to
pay some percentage of the full fee. A discounted/sliding fee scale applies only to direct patient
charges. Billing for third party coverage (Medicare, Medicaid, SCHIP or private insurance carriers) is
set at the usual and customary full charge.
Why have a discounted/sliding fee scale?
NJLRP requirements prescribe that a locally determined discounted/sliding fee scale be used, and that
services be provided either at no fee or a nominal fee, as determined by the practice.
Which patients are covered by a discounted/sliding fee scale?
By joining the NJLRP and accepting NJLRP clinicians into your practice, you are agreeing to apply the
discounted/sliding fee scale equally, consistently, and on a continuous basis to all recipients of services
in your site and/or location, without regard to the particular clinician that treats them.
How do we develop a discounted/sliding fee scale?
When developing a discounted/sliding fee scale, each placement site should take the following into
consideration:
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The discounted/sliding fee scale must be in writing and non-discriminatory;
No patient should be denied services due to an inability to pay;
Signage is posted to ensure that patients are aware that a discounted/sliding fee scale is
available to them;
Patients must complete written documentation to determine financial eligibility for the
discounted/sliding fee scale;
Patients below poverty are charged a nominal fee or not charged at all;
Clinical practice sites may establish any number of incremental percentages (discount pay
classes) as they find appropriate between 100-200% of poverty;
Patients above 200% of poverty may be charged full fees for services, OR clinical practice
sites may continue to charge incremental percentages for services until 100% of the full fee
is reached.
How and when is patient eligibility determined?
The simplest approach is to accept the patient’s word at the time the request is made. On future visits,
it may be appropriate to require some form of verification. Verification will typically include tax returns
and current pay stubs. Eligibility also may be based on current participation in certain federal/state
public assistance programs, including:
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Social Security Disability Income (SSDI);
Temporary Assistance for Needy Families (TANF);
Free or Reduced School Lunch Program;
Other public assistance programs.
Whose income should be counted?
Many placement sites count only the mother, father, and dependent children under 18 as the family.
Other adults in the household, even though related, are considered separately.
Is every patient’s income reviewed?
This is up to the individual practice. Whatever methodology is used, it must be uniformly and evenly
applied, without discrimination of any kind.
What are the federal poverty guidelines?
The poverty guidelines are a version of the income thresholds used by the Census Bureau to estimate
the number of people living in poverty. The thresholds are annual income levels below which a person
or family members are considered to be living in poverty. The income threshold increases by a constant
amount for each additional family member. The guidelines are updated annually to account for
increases in the Consumer Price Index.
Who issues the poverty guidelines?
HHS is required by law to issue the guidelines, which determine 100% of the Federal Poverty Level.
Poverty guidelines are published annually in the Federal Register and usually appear by early
February. Updates may be found at http://aspe.hhs.gov/poverty/.
SLIDING FEE SCALE
SAMPLE A
Incorporates 2015 HHS Poverty Guidelines
Family Size
1
2
3
4
5
6
7
8
9
10
11
12
$11,770
M
M
M
M
M
M
M
M
M
M
M
M
M = Minimum Charge
$15,930
D
M
M
M
M
M
M
M
M
M
M
M
$20,090
D
D
M
M
M
M
M
M
M
M
M
M
D = Pay 25%
or discount 75%
$24,250
D
D
D
M
M
M
M
M
M
M
M
M
C = Pay 50%
$28,410
D
D
D
D
M
M
M
M
M
M
M
M
$32,570
C
D
D
D
D
M
M
M
M
M
M
M
B = Pay 75%
or discount 25%
$36,730
C
C
D
D
D
D
M
M
M
M
M
M
$40,890
B
C
C
D
D
D
D
M
M
M
M
M
A = Pay 100%
SLIDING FEE SCALE
SAMPLE B
Incorporates 2015 HHS Poverty Guidelines
Family Size
1
2
3
4
5
6
7
8
Patient pays
0%
of charges
$11,770
$15,930
$20,090
$24,250
$28,410
$32,570
$36,730
$40,890
Patients pays
20%
of charges
$11,771- $17,655
$15,931 - $23,895
$20,091 - $30,135
$24,251 - $36,375
$28,411 - $42,615
$32,571 - $48,855
$36,731 - $55,095
$40,891 - $61,335
Patients pays
40%
of charges
$17,656 - $23,540
$23,986 - $31,860
$30,136 - $40,180
$36,376 - $48,500
$42,616 - $56,820
$48,856 - $65,140
$55,096 - $73,460
$61,336 - $81,780
Patients pays
60%
of charges
$23,541 - $26,483
$31,861- $35,843
$40,181 - $45,203
$48,501 - $54,563
$56,821 - $63,923
$65,141 - $73,283
$73,461 - $82,643
$81,781 - $92,003
Patients pays
80%
of charges
$26,484 - $29,425
$35,844 - $39,825
$45,204 - $50,225
$54,564 - $60,625
$63,924 - $71,025
$73,284 - $81,425
$82,644- $91,825
$92,004-$102,225
Patients
pays
100%
of charges
$29,426
$39,826
$50,226
$60,626
$71,026
$81,426
$91,826
$102,226
SLIDING FEE SCALE
SAMPLE C
Incorporates 2015 HHS Poverty Guidelines
Annual
Family Size
1
2
3
4
5
6
7
8
No Charge
$11,770
$15,930
$20,090
$24,250
$28,410
$32,570
$36,730
$40,890
25% of Fee
$14,713
$19,913
$25,113
$30,313
$35,513
$40,713
$45,913
$51,113
50% of Fee
$17,655
$23,895
$30,135
$36,375
$42,615
$48,855
$55,095
$61,335
75% of Fee
$20,598
$27,878
$35,158
$42,438
$49,718
$56,998
$64,278
$71,558
Full Fee
$23,540
$31,860
$40,180
$48,500
$56,820
$65,140
$73,460
$81,780
75% of Fee
$1,716
$2,323
$2,930
$3,536
$4,143
$4,750
$5,356
$5,963
Full Fee
$1,962
$2,655
$3,348
$4,042
$4,735
$5,428
$6,122
$6,815
75% of Fee
$858
$1,162
$1,465
$1,768
$2,072
$2,375
$2,678
$2,982
Full Fee
$981
$1,328
$1,674
$2,021
$2,368
$2,714
$3,061
$3,408
75% of Fee
$792
$1,072
$1,352
$1,632
$1,912
$2,192
$2,472
$2,752
Full Fee
$905
$1,225
$1,545
$1,865
$2,185
$2,505
$2,825
$3,145
75% of Fee
$396
$536
$676
$816
$956
$1,096
$1,236
$1,376
Full Fee
$453
$613
$773
$933
$1,093
$1,253
$1,413
$1,573
Monthly
Family Size
1
2
3
4
5
6
7
8
No Charge
$981
$1,328
$1,674
$2,021
$2,368
$2,714
$3,061
$3,408
Family Size
1
2
3
4
5
6
7
8
No Charge
$490
$664
$837
$1,010
$1,184
$1,357
$1,530
$1,704
25% of Fee
50% of Fee
$1,226
$1,471
$1,659
$1,991
$2,093
$2,511
$2,526
$3,031
$2,959
$3,551
$3,393
$4,071
$3,826
$4,591
$4,259
$5,111
Semi-Monthly
25% of Fee
50% of Fee
$613
$736
$830
$996
$1,046
$1,256
$1,263
$1,516
$1,480
$1,776
$1,696
$2,036
$1,913
$2,296
$2,130
$2,556
Family Size
1
2
3
4
5
6
7
8
No Charge
$453
$613
$773
$933
$1,093
$1,253
$1,413
$1,573
25% of Fee
$566
$766
$966
$1,166
$1,366
$1,566
$1,766
$1,966
Family Size
1
2
3
4
5
6
7
8
No Charge
$226
$306
$386
$466
$546
$626
$706
$786
25% of Fee
$283
$383
$483
$583
$683
$783
$883
$983
Bi-Weekly
50% of Fee
$679
$919
$1,159
$1,399
$1,639
$1,879
$2,119
$2,359
Weekly
50% of Fee
$340
$460
$580
$700
$820
$940
$1,060
$1,180