Check Your Sliding Fee Discount Policy Starter Kit (Free Templates)
Everything you need to structure a compliant, equitable, and funder-ready Sliding Fee Discount Program — including a sample policy, income guidelines, and patient-facing forms.
Download the Free Starter KitWhy This Matters
An incomplete or outdated Sliding Fee Discount Program is one of the most common causes of HRSA OSV conditions — and delays in FQHC designation.
Too many clinics:
- Don’t use the most recent federal poverty guidelines
- Fail to apply discounts across all eligible services
- Can’t show how they communicate the policy to patients
- Don’t document family size and income correctly
- Lack a board-approved written policy
This starter kit helps you build a fully compliant, patient-friendly program.
What’s Included in the Starter Kit
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Sample Sliding Fee Discount Policy (Word Doc)
Editable, HRSA-aligned language
Includes income-based scale tiers, family size, and scope of services
2025 Federal Poverty Guidelines Reference (PDF)
For determining eligibility thresholds and discount brackets
Patient-Facing Income Assessment Form (Fillable PDF)
HIPAA-safe structure to determine and document eligibility
Signage Sample (Awareness Poster Template)
Example text clinics can display to inform patients about the SFD program
Who This Is For
- Clinics preparing to apply for FQHC or Look-Alike status
- Health centers updating compliance documents pre-OSV
- New community clinics that need to set fee structures
- Existing FQHCs unsure if their current policy is compliant
- Admins and compliance officers tasked with documentation
If you’re not 100% confident in your SFD policy — this kit is for you.
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After Download: What to Expect
- Instant access to templates and forms
- Optional invitation to schedule a review call
- Email sequence with SFD best practices and audit prep tips
Success Story
“We had a fee scale but no formal policy — and we weren’t posting anything visibly for patients. Elvora Health helped us correct all of it before our OSV.”
— Executive Director, Riverstone Health
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Build a Sliding Fee Program That’s Compliant — and Patient-Friendly
Get the policy template, documentation tools, and guidance you need to meet HRSA and FTCA standards.
Download the Free Starter Kit