This program is designed to provide free or discounted care to those who have no means, or limited means, to pay for their medical services. In addition to quality healthcare, patients are entitled to financial counseling by a member of our team who can understand and offer possible solutions for those who cannot pay in full.

PCS will offer a Sliding Fee Discount Program to all who are unable to pay for their services. PCS will base program eligibility on a person’s ability to pay and will not discriminate on the basis of age, gender, race, sexual orientation, gender identity, religion, disability, or national origin. The Federal Poverty Guidelines are used in creating and annually updating the sliding fee schedule (SFS) to determine eligibility.


The following guidelines are to be followed in providing the Sliding Fee Discount Program


PCS will notify patients of the Sliding Fee Discount Program by:

  • Sliding Fee Discount Program Policy will be included in the Client Handbook.
  • Notification of the Sliding Fee Discount Program will be offered to each patient upon admission.
  • An explanation of our Sliding Fee Discount Program is available on PCS’ website.
  • PCS places notification of the Sliding Fee Discount Program in the clinic waiting area.

Essential Services will not be denied based on a client’s inability to pay.

Request for discount

Requests for discounted services may be made by patients, family members, social services staff or others who are aware of existing financial hardship. The sliding Fee Discount Program will only be made available for clinic visits. Information and forms can be obtained from the Front Desk Staff Members.


The Sliding Fee Discount Program will be administered through the Director of Accounts Receivables or his/ her designee. Information about the program and assistance with the application is available at the Front Desk. Dignity and confidentiality will be respected for all who seek and/ or are provided services under the Sliding Fee Discount Program.

Completion of Application

The patient/ responsible party must complete the Sliding Fee Discount Program application in its entirety. By signing the Sliding Fee Discount Program application, persons authorize PCS to verify income as disclosed on the application form. Providing false information on a Sliding Fee Discount Program application will result in all Sliding Fee Discount Program discounts being revoked and the full balance of the account(s) restored and payable immediately. If an application is unable to be processed due to the need for additional information, the applicant has two weeks from the date of notification to supply the necessary information without having the date on their application adjusted. If a patient does not provide the requested information within the two-week time period, their application will be re-dated to the date on which they supply the requested information. Any accounts balances resulting from a patient’s delay in providing information will not be considered for the Sliding Fee Discount Program.


Discounts will be based on income and family size only. PCS uses the Census Bureau’s definitions of each.

  1. Family 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.
  2. Income includes earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, education assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources. Noncash benefits (such as food stamps and housing subsidies) do not count.

Income verification

Applicants must provide one of the following:

  1. Prior year W-2
  2. Three most recent pay stubs
  3. Letter from employer detailing hours worked and salary/ hourly rate.
  4. Form 4506-T (if W-2 was not filed)
  5. Self-employed individuals will be required to submit detail of the most recent three months of income and expenses for the business.
  6. Self-declaration of Income may only be used in special circumstances. Specific examples include participants who are homeless. Patients who are unable to provide written verification must provide a signed statement of income, and why he/ she is unable to provide independent verification. This statement will be presented to PCS CEO or his/ her designee for review and final approval as to the sliding fee percentage. Self-declared patients will be responsible for 100% of their charges until management determines their appropriate category.


Those with incomes at or below 100% of the poverty level and are ineligible for the BHSN program may be eligible for the Sliding Fee Discount Program. Those with incomes above 100%, but at or below 200% of poverty, will be charged according to the sliding fee schedule. The sliding fee schedule will be updated during the first quarter of every calendar year with the latest Federal Poverty Guidelines.

Nominal Fee

Patients receiving a full discount will be assessed a $20 nominal charge per visit. However, patients will not be denied essential services due to an inability to pay.

Waiving of Charges

In certain situations, patients may not be able to pay the nominal fee. Waiving of charges may only be used in special circumstances and must be approved by PCS’ CEO or his/ her designee. Any waiving of charges should be documented in the patient’s file along with an explanation (e.g., inability to pay, good will, health promotion event).

Applicant notification

The Sliding Fee Discount Program determination will be provided to the applicants in writing and will include the percentage of Sliding Fee Discount Program write -off or, if applicable, the reason for denial. If the application is approved for less then a 100% discount or denied, the patient and/or responsible party must immediately establish payment arrangements with PCS. Sliding Fee Discount Program applications will cover balances incurred within the 12 months after the approved date, unless their financial situation changes significantly. The applicant has the option to reapply after the 12 months have expired or anytime there has been a significant change in family income.

Refusal to Pay

If a patient verbally expresses an unwillingness to pay or vacates the premises without paying for services, the patient will be contacted in writing regarding their payment obligations. If the patient does not make effort to pay or fails to respond within 60 days, this constitutes refusal to pay. At that point in time, PCS can explore options not limited to, but including, offering the patient a payment plan, waiving of charges, or referring the patient to collections.

Record keeping

information related to the Sliding Fee Discount Program applications and decisions will be scanned into the patient’s electronic chart as proof of income and approval or disapproval of participation. The Director of AR will maintain a monthly log of recipients and dollar amounts written-off. Denials will also be logged.

Policy and procedure review

Annually, the amount of Sliding Fee Discount Program provided will be reviewed by the CEO and/ or his/ her designee. The SDS will be updated based on the current Federal Poverty Guidelines. Pertinent information comparing amounts budgeted and actual community care provided shall serve.


During the annual budget process, and estimated amount of Sliding Fee Discount Program service will be placed into the budget as a deduction from revenue. Board approval for Sliding Fee Discount Program will be sought as an integral part of the annual budget.