How to Prepare for an NHSC Site Visit

When a date is confirmed, the Division of Regional Operations (DRO) staff from the Bureau of Health Workforce (BHW) will request these documents beforehand:

Policies on Non-Discrimination. Submit a copy of the site's policies on non-discrimination of patients based upon the individual's inability to pay; whether payment for services would be made under Medicare, Medicaid, or CHIP; and the individual's race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity.

Sliding Fee Discount Program Documents.

Submit the following:

• Policy on the Sliding Fee Discount Program
  • Applies to all residents of your site's HPSA(s)
  • Includes the following information:
    • Definitions of income and family size
    • Patient eligibility procedures
    • Frequency of re-evaluation of eligibility
    • Advertisement of the sliding fee discount program to the patient population
    • Nominal charge, if applicable
    • Collections policy, if applicable
• Sliding Fee Schedule
  • Based on most current Federal Poverty Guidelines (FPG)
  • It is calculated based on Family Size/Income
  • Goes up to at least 200% of FPG
  • Offers full discount for families with income at or below 100% of FPG
  • Adjust fees based on family size and income for families with incomes above 100% and at/below 200% of the FPG
• Patient Application for Sliding Fee Discount Program
• Posted Signage Notifying Patients about the Sliding Fee Discount Program
  • Submit two photographs of the posted signage. The sign must explicitly state that "no one will be denied access to services due to inability to pay; and there is a discounted/sliding fee schedule available based on family size and income."
    • The first photograph must show the sign prominently displayed in a common area visible to patients.
    • The second photograph must be a close-up photo, so the text is legible.
    • Sites may not use the NHSC poster and/or logo until after they are approved by the NHSC.
• Online Signage Notifying Patients about the Sliding Fee Discount Program
  • Submit a document with the screenshot and link to the published online statement on the site's official website (if one exists) or social media platforms (if applicable.) The screenshot must explicitly state that "no one will be denied access to services due to inability to pay; and there is a discounted/sliding fee schedule available based on family size and income."

Note, if your site type is exempt from implementing a Sliding Fee Discount Program, you must provide documentation explaining that no one is charged or billed for services, and individuals are not denied service because of inability to pay.

Proof of Access to Ancillary, Inpatient, and Specialty Care. Submit proof of referral arrangements not available on-site. Behavioral health sites must also submit documents outlined in item #4 below.

Acceptable documents include:

• Signed Memorandums of Understanding (MOU)
• Signed Memorandums of Agreement (MOA)
• Signed contracts with ancillary, inpatient, and specialty facilities

If formal referral arrangements do not exist, the applicant site should provide a dated and signed description of how it refers patients to ancillary, inpatient, and specialty care.

NHSC Comprehensive Behavioral Health Services Checklist and Supporting Documentation. If your site provides behavioral health and/or substance use disorder services on-site, you must provide the following:

• A completed Comprehensive Behavioral Health Services Checklist (PDF - 206 KB)
• Documentation demonstrating the provision of core services on-site and non-core services either on-site, in-network, or off-site, through referral, affiliation, or contract

NHSC Site Data Tables. Submit NHSC Site Data Tables (PDF - 203 KB) with information on the individual site location that:

• Includes data from the previous six continuous months
• Demonstrates site's sound fiscal management policies

Substance Use Disorder (SUD) Documentation. Facilities providing opioid treatment and/or SUD treatment services must provide the following documentation:

• Opioid Treatment Programs (OTPs): SAMHSA OTP certificate
• Office-based opioid treatment (OBOT): medications for opioid use disorder (MOUD) attestation letter describing the size of MOUD patient panel for last six (6) months
• Non-opioid outpatient SUD facilities: documentation of services

Clinician Recruitment and Retention Plan. The document must clearly state the policies and processes to recruit and maintain clinical staffing levels needed to appropriately serve your community, including specific strategies aimed at promoting clinician resiliency and reducing burnout.