Next Step Holistic Counseling Center
Financial Assistance Policy (FAP)
Effective Date: January 1, 2025
Purpose
Next Step Holistic Counseling Center is dedicated to ensuring holistic mental health services are accessible to all clients, including those facing financial hardship. This Financial Assistance Policy (FAP) outlines the process for clients to receive reduced copays, deductibles, or session fees, with discretionary assistance for significant financial hardships, in compliance with legal, ethical, and insurance standards.
Scope
This policy applies to all clients receiving services at Next Step Holistic Counseling Center who are unable to pay standard fees, copays, or deductibles due to financial hardship, whether insured, underinsured, or uninsured.
Definitions
Financial Hardship: Inability to pay for services due to low income or significant expenses, such as medical bills, housing costs, unemployment, childcare, or other financial burdens.
Federal Poverty Guidelines (FPG): Annual income thresholds published by the U.S. Department of Health and Human Services, used to assess eligibility.
Copay/Deductible: Out-of-pocket costs required by a client’s insurance plan.
Sliding Scale Fee: Reduced session fee based on income or hardship.
Eligibility
Clients may qualify for financial assistance if they meet one of the following:
-Household income is at or below 250% of the FPG for their household size.
-They face significant, documented financial hardship (e.g., medical bills, housing costs, unemployment, childcare expenses, or other major financial burdens) that severely limits their ability to pay, even if income exceeds 250% FPG (subject to discretionary review).
-They cannot afford copays, deductibles, or standard fees without compromising basic needs (e.g., housing, food, medical care).
Types of Assistance
Based on eligibility and available resources, Next Step may provide:
-Copay Reduction/Waiver: Partial or full reduction of copays, if permitted by the client’s insurance plan.
-Deductible Discount: Partial reduction of deductibles, with remaining balances covered by payment plans.
-Sliding Scale Fees: Session fees of $15-$45 for uninsured or underinsured clients (standard rate: $100).
-Payment Plans: Interest-free installments over 3-12 months, tailored to the client’s financial capacity.
-Discretionary Hardship Assistance: For clients with significant documented financial hardships (e.g., medical bills, rent arrears, unemployment, childcare costs, or other major expenses), the center may offer:
-Up to 75% copay/deductible reductions or $15-$45 session fees, regardless of income.
Assistance is capped at $1,500 per client annually to ensure sustainability.
Application Process
Request Assistance: Clients may request assistance during intake, at billing, or any time by contacting the office or visiting www.nextstep-hcc.com/fap. FAP forms are available in the office and online.
Submit Application: Include the FAP Application Form with proof of income (e.g., 2 recent pay stubs, tax return, or benefits statement) and household size.
Discretionary Hardship Application: Include documentation of financial hardship (e.g., medical bills, utility bills, eviction notices, unemployment benefits, childcare invoices) and a brief explanation of how the hardship impacts ability to pay.
Review
Standard applications are reviewed by the Office Manager within 7 business days.
Discretionary hardship requests are evaluated by a two-person review team (Office manager and Center Director) to ensure fairness, with decisions within 10 business days.
Notification: Clients receive written approval or denial, including details of assistance or appeal instructions.
Appeal: Clients may appeal denials within 10 days by submitting additional documentation or requesting a meeting with the Center Director.
Assistance Levels
Standard Assistance (Income-Based):
≤150% FPG: 75-100% copay/deductible reduction; $15-$25 session fees.
151-250% FPG: 50-75% copay/deductible reduction; $25-$45 session fees; payment plans up to 12 months.
Discretionary Hardship Assistance
For clients with documented financial hardships (e.g., medical bills, housing costs, unemployment, childcare, or other significant expenses), the review team may approve:
25-75% copay/deductible reduction or $15-$45 session fees, regardless of income, based on the severity of the hardship.
Payment plans or partial reductions, capped at $1,500 per client annually, and total assistance is capped at 4% of annual revenue to ensure financial sustainability.
Compliance with Legal and Ethical Standards
Insurance Contracts: Copay/deductible waivers, including discretionary ones, are verified with insurers to ensure compliance. Routine waivers without documented need are prohibited.
Federal/State Laws: Assistance adheres to the Anti-Kickback Statute, Civil Monetary Penalties Law, and state billing regulations. Hardship must be verified with documentation (e.g., bills, income statements).
Non-Discrimination: Assistance is provided equitably, without regard to race, gender, age, or other protected characteristics, per federal and state laws.
HIPAA: Financial documentation is stored in HIPAA-compliant systems, accessible only to authorized staff.
Ethical Guidelines: Assistance is not used to pressure clients into unnecessary services, per American Counseling Association (ACA) ethical codes.
Client Responsibilities
Provide accurate and complete financial information, including hardship documentation.
Submit applications within 30 days of billing, with exceptions for urgent cases.
Adhere to payment plan terms to maintain assistance eligibility.
Notify Next Step of changes in insurance or financial status.
Billing and Transparency
Clear Billing: Clients receive itemized bills showing charges, insurance payments, copays/deductibles, and FAP adjustments.
Pre-Service Disclosure: Estimated costs and FAP availability are discussed before non-emergency services.
Documentation: All applications, hardship documents (e.g., medical bills, utility bills), and assistance decisions are recorded and retained for 7 years for audits.
Limitations
Resource Constraints: Assistance is limited to 4% of annual revenue to ensure practice viability.
Insurance Restrictions: Some insurers may prohibit copay/deductible waivers, prompting alternative assistance (e.g., sliding scale fees, payment plans).
Exclusions: Non-covered or elective services (e.g., non-therapeutic workshops) are not eligible for FAP.
Ethical Considerations
No Coercion: Financial assistance does not influence treatment plans or service continuation.
Care Continuity: If clients cannot afford services despite assistance, they are referred to low-cost or pro bono providers with ethical termination procedures.
Confidentiality: Financial and hardship information is treated with clinical-level privacy.
Contact Information
For FAP inquiries or applications:
Office Manager: Lynn Charping
Phone: (989) 289-7761
Email: lynnc@nextstep-hcc.com
Address: 284 Hillcrest St., Harrison, MI 48625
Policy Updates
The FAP is reviewed annually or as needed to reflect regulatory or practice changes. Updates are posted online and communicated to clients.