SLIDING FEE SCHEDULE

 

Integrea’s charges for services are based on the cost of services. Funding from state, federal, and local governments helps cover the cost of some services. Fees charged to Mental Illness, Substance Abuse, and Development Disability consumers will be determined based on gross household income and number of dependents. Consumers who reside in residential programs are charged a non-negotiable room and board fee. Consumers at or below 100% of the Federal Poverty Guidelines will be charged a nominal fee for intake, individual therapy, group therapy, family therapy, physician assessment, medication monitoring, medication administration – injections, and hospital screenings. Sliding Fee Discount Program information is available on the Integrea Community Mental Health System website, posted in the clinic waiting area, and discussed with each new consumer at intake.

 

• Fees are determined based on the consumer’s total gross household income and number of dependents. Household is defined as” a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family. The income of other family members living in the home is included in the calculation of total household income only if such family members are in a legally dependent relationship with the consumer. Non-related household members are also accepted when calculating family size.

 

• All consumers are automatically reviewed for eligibility at intake based on household size and income. Consumers do not have to apply separately for sliding fee discount program eligibility. Verification of income is required. Sources for income verification include, but are not limited to: copies of weekly/monthly pay checks or disability checks, letters of verification from income sources such as the Department of Human Resources, federal or state income tax returns or, if the consumer has no income, a letter from a family member or social service agency to verify that the consumer has no income.

 

 

• All sources of income must be included in the calculation of a consumer’s discounted fees; e.g., child support or disability income, etc.

 

• The income of step-parents is not included in the calculation of discounted fees for children and adolescents, unless they are legal guardians of the child/adolescent.

 

• Integrea’s Board approved Fee Calculation Table is used to calculate consumer’s fees for services and is based on the Federal Poverty Guidelines (FPG). A full discount is given for those at or below 100% of the FPG, with allowance for a nominal charge.

 

Nominal charges will be as follows:

Intake                                                                         $10.00

Individual Therapy                                                     $3.00

Group Therapy                                                           $3.00

Family Therapy                                                           $3.00

Physician Assessment                                              $8.00

Medication Monitoring                                             $3.00

Medication Administration – injections                $3.00

Hospital Screening                                                   $3.00

 

• Children 16 years of age and older may seek treatment independent of their parent’s involvement or knowledge. In such cases, only the child’s income will be considered in the calculation of the child’s fee.

 

• Services are not denied because of a consumer’s inability to pay for services. Discounts are provided for those above 100% but at or below 200% of the FPG in accordance with the sliding fee scale. In exceptional circumstances, the Chief Financial Officer may approve an adjustment in the fee, or terms of payment, to ensure that no consumer is denied services because of a legitimate inability to pay for services. Consumers who exceed 200% of the Federal Poverty Guidelines will be subject to Integrea’s standard collection fees and procedures.

 

• The responsible party for all charges related to Integrea services will be the consumer or their legal guardian, unless otherwise specified.

 

• With the exception of room and board and residential rehabilitation, third party contractual agreements, and other grant/contractual restrictions, all Integrea fees for service are subject to a self-pay charge.

 

• Consumers are responsible for informing Integrea of changes in their financial circumstances, and providing supporting documentation to Integrea of these changes in income or dependents. Consumers who were not eligible at intake but who have a change in financial circumstances, should alert staff to be reevaluated for sliding fee discounts.

 

• Fees will be re-evaluated annually, upon the first quarter of the calendar year and based upon the current FPG or as consumer information changes.

 

• Payments from third-party payers are accepted, and deductibles and co-pays will be charged without discount.

 

• Consumers with a third-party coverage that does not cover or only partially covers fees for certain services, may also be eligible for the sliding fee discount program. Eligibility is subject to legal and contractual limitations by the insurance company.

 

• All payments will be credited to consumer accounts. If a credit balance occurs, a refund will be issued to the consumer. Statements are issued quarterly.

 

 

• Consumers will be notified if the fee calculation schedule changes.

• Consumers are provided full disclosure of services provided, including any applicable charges for these services, and any limitation(s) based on the duration of the services.

 

1. Upon admission, Integrea will discuss with the consumer and/or legally authorized guardian/advocate/representative, and shall provide every consumer a written statement of, services that will be provided to the person and related charges, including limitations placed on the duration of services and/or charges related to such services.

 

2. Persons who are responsible for payment of charges for services shall be informed of any changes in services or limitations placed on duration of services prior to their occurrence during the service relationship.

 

3. All information shall be presented to the consumer or responsible party in language and terms appropriate to the person’s ability to understand.

 

4. Discounts remain in effect for 12 months. After 12 months, consumers complete a reassessment for discount eligibility.

 

 

• Support staff are responsible for encouraging consumers to pay their self-pay charges for services as they are provided. Clinical staff should be kept informed of incidents of a consumer’s refusal to pay for services in order that the issue may be addressed clinically.