Associated Therapeutic Services PC (ATS Counseling) is committed to making outpatient behavioral health services accessible to individuals and families regardless of their ability to pay.

No one will be denied access to services due to an inability to pay. A discounted/sliding fee schedule is available based on family size and income.

Eligibility

The Sliding Fee Discount Program is available to individuals and families with annual income at or below 200% of the current Federal Poverty Guidelines. Eligibility is determined solely by family size and income.

Eligibility is not determined by insurance status, assets, credit history, payment history, citizenship, diagnosis, or any other factor. ATS does not require an applicant to apply for Medicaid or other insurance or provide a Medicaid denial letter before applying for the program.

Approved eligibility remains in effect for six months. Patients must reapply every six months and may request a new determination sooner if their family size or income changes significantly.

Definition of Family Size

For purposes of this program, a family includes one person living alone or two or more people related by birth, marriage, or adoption who reside together. Related subfamily members residing in the household are included. Non-related household members are included when they reside together and share financial responsibility for the patient’s care.

ATS will apply this definition consistently to all applicants.

Definition of Income

Income means gross income before taxes received by all family members whose income is included in the eligibility determination. Income may include:

• Wages, salaries, and tips
• Business or self-employment income
• Unemployment or workers’ compensation
• Social Security and Supplemental Security Income
• Veterans’ benefits
• Pension or retirement income
• Survivor benefits
• Interest, dividends, and royalties
• Income from rental property, estates, or trusts
• Alimony and child support
• Financial assistance received from outside the household
• Other regular sources of income

ATS may calculate annual income using the applicant’s current income when prior-year income does not accurately reflect the family’s present financial circumstances.

Documentation and Verification

Applicants must complete and sign the ATS Sliding Fee Discount Program application. Acceptable income documentation may include one or more of the following:

• Two recent pay stubs
• A prior-year W-2 or income tax return
• A written statement from an employer
• Documentation of Social Security, unemployment, retirement, or other benefits
• For self-employed applicants, documentation of income and business expenses for the most recent three months
• Other reliable documentation showing current income

When written documentation is unavailable, ATS may accept a signed self-declaration of income. Information is requested only to establish family size and income. ATS does not use credit checks, payment history, asset tests, Medicaid denial letters, or net-worth calculations to determine eligibility.

Application of Discounts

ATS applies the Sliding Fee Discount Program uniformly to eligible uninsured and underinsured patients.

• At or below 100% of the Federal Poverty Guidelines: The patient receives a full discount and is charged $0 for qualifying services.

• Above 100% and at or below 200% of the Federal Poverty Guidelines: The patient receives a partial discount according to the current ATS Sliding Fee Schedule. The discount is based solely on family size and income.

• Above 200% of the Federal Poverty Guidelines: The patient does not qualify for a sliding fee discount.

For insured or underinsured patients, the applicable discount may be applied to the patient-responsibility portion of the charge, including eligible deductibles, coinsurance, copayments, or non-covered services, unless the patient’s insurance contract or applicable law prohibits the discount.

The program applies to NHSC-covered primary behavioral and mental health services provided by the participating ATS location. ATS updates its Sliding Fee Schedule at least annually to reflect the most current Federal Poverty Guidelines.

Notification of Eligibility

ATS will provide applicants with notice of the eligibility decision. If approved, the notice will identify the approval period and applicable discount level. If an application is incomplete or not approved, ATS will explain what additional information is needed or the reason for the decision.

Collection of Patient Balances

ATS may send statements or payment reminders and may work with patients to establish affordable payment arrangements. ATS will not refer qualifying Sliding Fee Discount Program balances to an outside collection agency.

An unpaid balance does not change a patient’s SFDP eligibility and will not, by itself, result in denial of access to services. ATS distinguishes an inability to pay from an unwillingness to cooperate with reasonable payment arrangements.

Program Notification and Accessibility

ATS informs patients about the Sliding Fee Discount Program through:

• A prominent notice on the ATS website
• Signs displayed in patient waiting and reception areas
• Information provided during intake or admission
• Applications available through the front office
• Staff assistance with completing the application
• Information included with billing or payment communications when appropriate

Patients may request an application or assistance by calling 580-242-4673, texting 580-237-0332, or emailing ats@atscounseling.com. ATS will protect the privacy and confidentiality of all financial information submitted.

Annual Review

ATS will review this policy, its operating procedures, and the Sliding Fee Schedule at least annually. The Sliding Fee Schedule will be updated when new Federal Poverty Guidelines are issued. ATS will also review the program for practices that could create unnecessary barriers to care.