Is Your Sliding Fee Policy HRSA-Compliant? Let's Make Sure.
Everything you need to structure a compliant, equitable, and funder-ready Sliding Fee Discount Program — including a sample policy, income guidelines, patient-facing forms, and a signage template.
Why This Matters
An incomplete or outdated Sliding Fee Discount Program is one of the most common causes of HRSA OSV conditions — and one of the most common delays in FQHC designation. Yet most compliance gaps are preventable with the right documentation in place from the start.
This starter kit helps you build a fully compliant, patient-friendly program from the ground up.
- 01 Don't use the most recent Federal Poverty Guidelines for eligibility thresholds
- 02 Fail to apply discounts consistently across all eligible services
- 03 Can't demonstrate how they communicate the policy to patients
- 04 Don't document family size and income verification correctly
- 05 Lack a board-approved written policy that meets HRSA standards
What's Inside the Starter Kit
Sample Sliding Fee Discount Policy
- Editable, HRSA-aligned policy language in Word format
- Income-based scale tiers, family size adjustments, and scope of services
- Board approval documentation guidance included
Federal Poverty Guidelines Reference
- Current FPG reference table for determining eligibility thresholds
- Discount bracket structure aligned to HRSA requirements
- Notes on annual update process and documentation
Patient Income Assessment Form and Signage
- Fillable PDF income assessment form with HIPAA-safe structure
- Family size and income documentation fields
- Awareness poster template for patient-facing signage requirements
Who it's for
- 01Clinics preparing to apply for FQHC or Look-Alike designation
- 02Health centers updating compliance documents ahead of an Operational Site Visit
- 03New community clinics that need to build a fee structure from the ground up
- 04Existing FQHCs unsure whether their current SFD policy meets current standards
- 05Administrators and compliance officers responsible for HRSA documentation
What You'll Walk Away With
- An editable sample Sliding Fee Discount policy aligned to HRSA Program Requirements
- A Federal Poverty Guidelines reference PDF for setting correct discount thresholds
- A fillable patient income assessment form with HIPAA-safe structure
- A signage poster template to meet patient notification requirements
- Option to request a free policy compliance review from a MedCore compliance specialist
Send Me the Starter Kit
Enter your details and the full starter kit will land in your inbox within a few minutes.
Built by FQHC Specialists
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HIPAA-Aware Delivery
Forms and emails follow HIPAA marketing guidelines.
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No Spam, No Sales Pressure
The resource is yours regardless of what you do next.
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Built for FQHCs
Designed by consultants who work in the FQHC lifecycle daily.
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Regulator-Reviewed
Content reviewed against HRSA and HIPAA requirements.
Build a Sliding Fee Program That's Compliant — and Patient-Friendly.
If you'd like an expert review of your current policy or help preparing for an OSV, book a free compliance call with a MedCore advisor.