“To Fee or Not to Fee”

1. “To Fee or Not to Fee” Presented by Family Planning Council, Inc. for Southeast Pennsylvania January 20, 2010

2. Purpose of Today’s Training • Review requirements for assessing client fees • Describe income determination procedures for SelectPlan and fee assessment

3. Questions? • What specific questions or challenges do you have about fee assessment and/or collection?

4. Philosophy & Rationale • Why is fee assessment and collection important?

5. Philosophy & Rationale • Maximizes resources. • Helps people who are least able to pay. • All people should have access to services. • Attitude and communication is key to successful assessment and collection

6. Policy • Addressed in FPC’s “Charges, Billing, and Fee” policy • www.familyplanning.org/provider login • Based on Titles V, X, and XX • Scope and receipt of services must not be determined by method of payment or ability to pay.

7. Insurance and SelectPlan • Coverage under MA, SelectPlan for Women, and commercial insurance must be routinely ascertained • Fees may only be charged for uncovered services • Titles V, X, and XX should be the last resources utilized

8. Commercial Insurance • Clients with commercial insurance must be asked about the confidentiality of their services • If client concerned about EOB, then client should be fee assessed and insurance not billed • If insurance is not one that your agency bills, then you may assess fee • Co-pays/supplies/visit fees charged only if lower than fee schedule

9. Sliding Fee Schedule • Every agency must have one • FPC reviews during audits • Determined based on agency’s costs, circumstances, and funding sources • Must have at least five slides

10. Sliding Fee Schedule • Full fees charged based on reasonable costs • Charges for services or supplies not included in visit fee must too be on a sliding fee schedule based on reasonable costs • All fees charged based on Federal poverty level (FPL)

11. Federal Poverty Guidelines • Based on annual household income and family size • FPC’s PVA requires weekly income • SelectPlan requires monthly • Sample fee schedule show monthly

12. FPL & Fee Schedule • Clients at or below 100% of FPL cannot be charged a fee • Clients at or above 250% of FPL should be charged a full fee • Clients between 100% and 250% of FPL receive discounted fees (FPC requires at least three discount categories)

13. Income Determination • Must use self-declaration as reported by client • May not require written documentation • May request documentation, especially as it will eventually be necessary for SelectPlan approval

14. Income Determination • Agencies should assess SelectPlan eligibility for unenrolled clients and take applications • Parameters (household income and family size) are different • Fee assessment for FP services • Eligibility screening for SelectPlan

15. Family Size • SelectPlan eligibility screening • Defined as only the applicant, her spouse if living in the household, and her dependent children • Fee assessment for FP services • Defined as the number of individuals living in a household and supported by the income of that household

16. Household Income • SelectPlan eligibility screening • Includes only income of the applicant, spouse, and dependent children • Some sources are not counted • Fee assessment for FP services • Includes all sources of income • Unemployment and other public funding are counted

17. Documentation • Household size and income determination MUST be documented in the client’s chart

18. Adolescents under 18 years old • FREE services unless otherwise insured (paid for by Titles V and XX) • Some agencies have a waiver for this rule • Age should be reviewed at each visit • Coverage under MA must be ascertained • Commercial insurance can be used IF no confidentiality concerns

19. College Students • Fees must be based on income, as with all other clients • Income determined based on whose income is providing their support • May be eligible for SelectPlan • May be assessed a fee for FP services

20. Fee Balances • Must have procedures in place for adjusting balances based on circumstances (i.e., financial hardship) • Clients cannot be denied services if they carry a balance and are unable to pay

21. Denial of Services • When a client has refused to make payments against an open balance, client can be denied services/supplies only after being provided advanced written notice.

22. Denial of Services • FPC’s policy calls for: • Providing counseling (balance & responsibility) • Reviewing & possible reassessing fee status and ability to pay • Creating an appropriate payment plan, giving client opportunity to meet the new payment plan • Advising during a previous visit this might occur • Documenting warning in client record • Providing bill stating balance and minimum payment • BEFORE services are denied

23. Donations • May be accepted • Pressuring clients to make donations is not permitted • Does not reduce client balances

24. Questions?