Transforming Lives
Sliding Fee Discount Program Policy
Transformation Healthcare Inc. ensures that no individual is denied access to medically necessary behavioral health and substance use services due to financial hardship.
Health Equity
Reducing barriers to care for all individuals served
Financial Assistance
Income-based discounts using Federal Poverty Guidelines
Total Wellness
Supporting complete transformation for every patient
About the Program
What is a Sliding Fee Discount Program?
The Sliding Fee Discount Program is Transformation Healthcare Inc.’s commitment to ensuring that all individuals have access to essential behavioral health and substance use treatment services, regardless of their ability to pay.
This program allows eligible patients to receive services at a reduced cost based on their household size and gross income, in alignment with the current Federal Poverty Guidelines. Patients are responsible for paying a portion of the service fee according to where their income falls within the established sliding fee scale.
Program Overview
- Transformation Healthcare Inc. (THI) serves patients regardless of ability to pay.
- A sliding fee discount is available for eligible uninsured and underinsured patients based on household size and gross household income.
- Discount eligibility is determined using the current HHS Poverty Guidelines for the 48 contiguous states and the District of Columbia.
- Patients who qualify pay a reduced amount based on the discount tier shown below.
- No patient will be denied access to covered services because of inability to pay.
Financial Assistance
THI Discount Tiers
Income Level | Patient Responsibility | Discount | Application |
At or below 100% FPG | 0% of standard fee | 100% discount | Nominal/no charge for covered services |
101%–133% FPG | 10% of standard fee | 90% discount | Reduced patient payment |
134%–150% FPG | 15% of standard fee | 85% discount | Reduced patient payment |
151%–185% FPG | 25% of standard fee | 75% discount | Reduced patient paymen |
186%–200% FPG | 50% of standard fee | 50% discount | Reduced patient payment |
Above 200% FPG | 100% of standard fee | No sliding fee discount | Full THI self-pay charge applies |
2026 Federal Poverty Guidelines
Monthly Poverty Guideline Table
2026 HHS Poverty Guidelines — Monthly Income Thresholds for the 48 Contiguous States and D.C
Household Size | 100% | 133% | 150% | 185% | 200% |
1 | $1,330.00 | $1,768.90 | $1,995.00 | $2,460.50 | $2,660.00 |
2 | $1,803.33 | $2,398.43 | $2,705.00 | $3,336.17 | $3,606.67 |
3 | $2,276.67 | $3,027.97 | $3,415.00 | $4,211.83 | $4,553.33 |
4 | $2,750.00 | $3,657.50 | $4,125.00 | $5,087.50 | $5,500.00 |
5 | $3,223.33 | $4,287.03 | $4,835.00 | $5,963.17 | $6,446.67 |
6 | $3,696.67 | $4,916.57 | $5,545.00 | $6,838.83 | $7,393.33 |
7 | $4,170.00 | $5,546.10 | $6,255.00 | $7,714.50 | $8,340.00 |
8 | $4,643.33 | $6,175.63 | $6,965.00 | $8,590.17 | $9,286.67 |
Note. For households larger than 8, add $5,680 annually for each additional person, then apply the same percentage multiplier. Monthly thresholds are calculated by dividing annual income by 12.
What We Cover
THI Covered Service Categories
The following service lines may be covered under THI’s sliding fee discount program, subject to THI’s approved self-pay fee schedule and payer rules.
Service Category | Common CPT/HCPCS Reference | THI Standard Fee |
Outpatient Mental Health Evaluation / Intake | 90791 / 90721 program-specific intake code | $269.93 / $269.93 |
Individual Therapy | 90832 / 90834 / 90837 / H0004 | $79.32 / $144.14 / $144.14 / $31.06 per 15 Mins |
Family Therapy | 90846 / 90847 | $142.88 / $150.11 |
Group Therapy / Group Counseling | 90853 / H0005 as applicable | $64.81 / $60.62 |
Medication Management / Psychiatric Follow-Up | 99213 / 99214 / 99215 or applicable E/M code | $97.02 / $136.43 / $191.23 |
Substance Use Assessment | H0001 or applicable code | $220.65 |
Intensive Outpatient Program (IOP) | H0015 or applicable code | $194.23 |
Partial hospitalization (6+ hrs/day of services) | H2036-22 | $326.27 |
Partial Hospitalization | H2036 | $201.99 |
Psychiatric Rehabilitation Program (PRP) | H2018-U3 or applicable code | $1,205.88 |
Assertive Community Treatment (ACT) EBP | H0040-21 / H0040 | $1,876.22 / $1,330.41 |
Detailed Pricing
Fee Schedules Applied
SUD Fee Schedule Applied
Service | CPT | Full Fee | 0% | 10% | 15% | 25% | 50% |
Alcohol and/or Drug Assessment | H0001 | $220.65 | $0.00 | $22.07 | $33.10 | $55.16 | $110.33 |
Partial Hospitalization (6+ hrs/day | H2036-22 | $326.27 | $0.00 | 32.63 | $48.94 | $81.57 | $163.13 |
Partial Hospitalization | H2036 | $201.99 | $0.00 | $20.20 | $30.30 | $50.50 | $101.00 |
Intensive Outpatient (IOP) | H0015 | $194.23 | $0.00 | $19.42 | $29.13 | $48.56 | $97.11 |
Group Outpatient Therapy | H0005 | $60.62 | $0.00 | $6.06 | $9.09 | $15.15 | $30.31 |
Individual Therapy(per 15 min) | H0004 | $31.06 | $0.00 | $3.11 | $4.66 | $7.76 | $15.53 |
Mental Health Fee Schedule Applied
Service | CPT | Full Fee | 0% | 10% | 15% | 25% | 50% |
Mental Health Assessment | 90791 / 90792 | $269.93 | $0.00 | $26.99 | $40.49 | $67.48 | $134.97 |
Individual Therapy | 90834 | $144.14 | $0.00 | $14.41 | $21.62 | $36.03 | $72.07 |
Psychotherapyw/ E/M | 90836 | $166.73 | $0.00 | $16.67 | $25.01 | $41.68 | $83.36 |
PRP Service | H2018-U3 | $1,205.88 | $0.00 | $120.59 | $180.88 | $301.47 | $602.94 |
ACT Intensive | H0040-21 | $1,876.22 | $0.00 | $187.62 | $281.43 | $469.06 | $938.11 |
ACT Standard | H0040 | $1,330.41 | $0.00 | $133.04 | $199.56 | $332.60 | $665.21 |
Note: Monthly service fees (PRP and ACT) are prorated based on days of service when applicable.
Documentation
Required Income Verification
Acceptable Documents
Patients should provide at least one acceptable proof of income for each income-earning household member. Acceptable documentation may include:.
Most recent payroll check stubs (weekly = 4, biweekly = 2, monthly = 1 or more)
Most recent tax return or 1099 for self-employed individuals
SSI, SSDI, Social Security, pension, retirement, unemployment, or disability award letters
Bank statement showing direct deposit of benefit income
Documentation of child support, alimony, or other recurring support
Written self-attestation pending verification, when allowed by policy
Documentation deadline. Income verification should be submitted within 5 business days of the sliding fee application or attestation. If verification is not received, THI may apply the full self-pay charge until eligibility is finalized.
Eligibility Period Reference
Income Verification Document
Suggested Eligibility Period
Self-attestation pending proof of income
Up to 5 business days
No-income verification letter
6 months
Cash-income verification letter
6 months
Unemployment benefits
6 months
Payroll stubs
Annual or until material income change
1099 / tax return (self-employed)
Annual
SSI / SSDI / pension / retirement benefit
Annual
Appendix A
Patient Notice
SLIDING FEE DISCOUNT PROGRAM NOTICE
NOTICE TO PATIENTS:
Transformation Healthcare Inc. serves all patients regardless of ability to pay. Discounts for covered behavioral health and substance use services are available based on household size and income. For more information, please ask the front desk or request a sliding fee application.
AVISO PARA PACIENTES:
Transformation Healthcare Inc. atiende a todos los pacientes independientemente de su capacidad de pago. Hay descuentos disponibles para servicios cubiertos de salud mental y uso de sustancias según el tamaño de la familia y los ingresos. Para más información, solicite una solicitud de descuento en la recepción.
