POLICY: It is the policy of Kind Mind Psychology, to provide free or discounted mental health services to those who have no means, or limited means, to pay for their medical services (Uninsured or Underinsured).

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


1. Kind Mind Psychology notifies clients of the Sliding Fee Discount Program by prominently displaying notices in the lobby of our office where applicable. It is also posted on our website.

2. Clients must complete a Sliding Fee Discount Application to be considered for the program. A new form must be completed and evaluated every 12 months or if the clients financial situation changes.

3. 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.

4. 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, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources.

5. Income verification: Applicants may be asked to provide one of the following: prior year W-2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed). Self-employed individuals will be required to submit details of the most recent three months of income and expenses for the business. Adequate information must be made available to determine eligibility for the program.

6. Self-declaration of income may only be used in special circumstances. Specific examples include participants who are homeless. Clients who are unable to provide written verification must provide a signed statement of income, and why they are unable to provide independent verification. This statement will be presented for review and final determination as to the sliding fee percentage. Self-declared clients will be responsible for 100 percent of their charges until management determines the appropriate category.

7. Those with incomes at or below 100% of poverty will receive a full 100% discount. Those with incomes above 100% or poverty, but at or below 200% of poverty, will be charged according to the attached sliding fee schedule. The sliding fee schedule will be updated during the first quarter of every calendar year with the latest Federal Poverty Guidelines.

8. Patients receiving a full discount will be assessed a $40 nominal
charge per visit. However, patients will not be denied services due to an inability
to pay. The nominal fee is not a threshold for receiving care and thus, is not a
minimum fee or co-payment.

9. The determination will be provided to the client by phone within 3 business days. If approved, the applicant will be told right away the amount of the discount. If the applicant is denied, they may reapply after 12 months have expired or anytime there has been a significant change in family income. When the applicant reapplies, the look back period will be the lesser of six months or the expiration of their last Sliding Fee Discount Program application.

10. If a client verbally expresses an unwillingness to pay or vacate the premises without paying for services, the patient will be contacted in writing regarding their payment obligations. If the client is not on the sliding fee schedule, a copy of the sliding fee discount program application will be sent with the notice. If the patient does not make an effort to pay or fails to respond within 60 days, this constitutes refusal to pay. At this point in time, Kind Mind Psychology can explore options not limited, but including offering the client a payment plan, waiving of charges, or referring the client to collections.

11. Information related to the Sliding Fee Discount Program decisions will be maintained by the Administrative Assistant. Confidential files will be located in a secure centralized location in an effort to preserve the dignity of those receiving free or discounted care.