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INDIAN RIVER COUNTY HEALTH DEPARTMENT FEE SCHEDULE — Florida Administrative Code, Chapter 1OD-121 i I I I j For the purpose of family planning, sexually transmitted disease, or HIV/AIDS services only, minors seeking those services shall be considered a separate family for Income eligibility determination purposes and shag be assessfees for those ed e services based upon their own personal gross income. AM client who elects to waive the eligibility determination process shall be assigned to the full fee category. N there is no fee for a service, income eligibility does not need to be determined, except for WIC. The self -declaration statement shall include a signed acknowledgment that the statement is true at the time it is made, and that the person making the statement understands that the provider shall attempt to verify the statement. Verification can be secured by telephone, in written form, or by face-to-face contact, verification does not require a written document to confirm an applicant's or client's statement. If the provider is unable to verify wages paid or an employer will not verify wages paid, the self -declaratory statement provided by the applicant must be accepted as accurate. Clients served by CHD's and their subcontractors shall not be denied services for tuberculosis, sexually transmitted disease, or HIV/AIDS communicable disease control because of failure or inability to pay a prescribed fee, regardless of their Income. Clients interviewed, examined, or tested at IRCHO's initiative because they are a contact to a case of communicable disease or because they are a member of a group at risk that is being investigated by the IRCHD shall not be charged a fee for the interview, examination, or testing; these clients may be charged on a sliding fee scale for any treatment indicated, but they cannot be denied services based on inability to pay. Clients served by IRCHD and their subcontractors shall not be denied family planning services for failure or inability, to pay a prescribed fee, regardless of their income; however, the family planning services of inserting Norplant, and male and female sterilization, shall be limited depending on the availability of funds to pay for these services. Clients shall not be denied pregnancy testing for failure or Inability to pay. 1 7- Cllents may request a review of their fee charge on the basis that they have severe, unusual, and unavoidable expenses or obligations that substantially reduce their ability to pay and which warrant special consideration. IRCHD POum School Year Policy Regarding Physicals: If a patient is already established at IRCHD as a primary care patient, physicals will be given based on sliding fee scale; however, if they are new to the clinic for medical care, they must pay the advance fee of $25.00 unless they register as a primary care patient and transfer all current medical records to the health department County of Residence: (PrimaryCare) If a patient has Medicaid, other confirmed medical coverage, or prepays out of county charge, we will see them in the clink and bill for service. However, all sliding fee or zero pay patients must be seen at the health department in the county of their residence. Failure to show confirmation of county residence will result in payment of 100% until such confirmation Is obtained. (Exception to this rule will be for treatment of communicable diseases and family planning services.) Employee medical care will be provided based on approved policy and procedure. Hepatitis A & B vaccines are provided free of charge to ages 0-18 per CDC Vaccine for Children guidelines. H a patient has Medicaid coverage, Medicaid will cover Hep A & B to age 21. Vaccines will not be provided on a sliding fee scale for non -established patients over the age of 18. EXCEPTION: Vaccine will be provided free of charge or on reduced fee if vaccine Is treatment for communicable disease. Access to dental services will be limited to those patients who make less than 300% of the current Federal Poverty Level. Access to eye clink services will be limited to those patients who make less than 200% of the current Federal Povertv Level. Pape 7 of 7 7/11/2018