Rule 173-3-07 | Older Americans Act: consumer contributions.
(A) Introduction: All services paid, in whole or in part, with Older Americans Act funds are subject to voluntary contributions. All services paid, in whole or in part, with Older Americans Act funds are subject to cost sharing, except for services excluded by paragraph (C)(1) of this rule. All consumer contributions for services paid, in whole or in part, with Older Americans Act funds are subject to the requirements contained in 42 U.S.C. 3030c-2 and 45 C.F.R. 1321.67.
(B) Voluntary contributions: Each AAA is subject to the federal mandate under 42 U.S.C. 3030c-2 to consult with relevant service providers and older individuals in the AAA's planning and service area (PSA) to determine the best method for accepting voluntary contributions.
(1) A provider may do the following:
(a) Solicit consumers to contribute toward the cost of the services received and encourage any consumer to contribute if the consumer's self-declared income is at, or above, one hundred eighty-five per cent of the federal poverty guidelines, which the United States department of health and human services establishes annually according to 42 U.S.C. 9902 and publishes on https://aspe.hhs.gov/poverty-guidelines.
(b) Develop a suggested contributions schedule for voluntary contributions according to 45 C.F.R. 1321.67, but not use the schedule or any other means test to determine if a consumer is eligible to receive a service.
(2) A provider shall do the following:
(a) Clearly inform each consumer that contributions are purely voluntary. 42 U.S.C. 3030c-2 and 45 C.F.R. 1321.67 do not allow means testing or denial of a service to a consumer who does not contribute of the cost of the service.
(b) Protect the privacy and confidentiality of each consumer with respect to the consumer's contribution or lack of contribution.
(c) Safeguard and account for all voluntary contributions.
(d) Use collected voluntary contributions to expand the services for which consumers contributed, and supplement Older Americans Act funds for those services.
(C) Cost sharing:
(1) All services paid, in whole or in part, with Older Americans Act funds are subject to cost sharing, except for the following services:
(a) Information and assistance, outreach, benefits counseling, case management, disease prevention, health promotion, or volunteer placement.
(b) Education, training, or a support group provided through the national family caregiver support program.
(c) Congregate and home-delivered meals.
(d) Ombudsman, elder abuse prevention, legal assistance, or another consumer-protection service.
(2) Each AAA shall implement and administer a cost-sharing policy that includes all of the following:
(a) The following sliding-fee schedule, which determines the consumer's suggested cost-share percentage of the actual (or partial) contracted cost of a unit of a service based upon the consumer's individual income as a percentage of the federal poverty guideline. Under no circumstances may an AAA permit or obligate a consumer to participate in cost sharing when the consumer's income is below one hundred fifty per cent of the federal poverty guideline.
| INCOME | SUGGESTED COST SHARE |
| 149% and below | 0% |
| 150-174% | 10% |
| 175-199% | 20% |
| 200-224% | 30% |
| 225-249% | 40% |
| 250-274% | 50% |
| 275-299% | 60% |
| 300-324% | 70% |
| 325-349% | 80% |
| 350-374% | 90% |
| 375%and above | 100% |
(b) A requirement to determine the consumer's income solely by the consumer's self-declaration of income with no requirement for verification, and no consideration of the consumer's assets, savings, or other property.
(c) A procedure for collecting cost-sharing payments from consumers, including from consumers receiving participant-directed services.
(d) A prohibition against denying services paid, in whole or in part, by Older Americans Act funds due to the income of the consumer or the consumer's failure to make a cost sharing payment.
(e) A requirement to widely distribute written materials to consumers that describe the requirements for cost sharing, the services subject to cost sharing, the procedure for cost sharing, the sliding-fee schedule published in this rule, and a statement that a provider is prohibited from denying services paid, in whole or in part, by Older Americans Act funds due to the income of the consumer or the consumer's failure to make a cost sharing payment.
(f) A requirement to provide a receipt to a consumer or caregiver who makes a payment.
(g) A procedure for safeguarding and accounting for all cost-sharing funds collected.
(h) A requirement to retain records of all cost-sharing funds collected.
(i) A requirement to keep the consumer's declaration or non-declaration of income and cost-sharing payment history confidential.
(j) A requirement to use the funds collected from cost sharing to expand the capacity to provide the service for which the funds were given, unless the funds are used to expand the pool of funds from which the care-coordinated services are paid.
(3) The AAA may request a waiver of the requirement in paragraph (C)(2) of this rule to implement and administer a cost-sharing policy. ODA shall approve the request if the AAA demonstrates to ODA, by a preponderance of the evidence, one of the following:
(a) At least eighty per cent of the consumers in the PSA have incomes below one hundred fifty per cent of the federal poverty guidelines.
(b) Cost sharing would be an unreasonable administrative or financial burden on the AAA.
Last updated January 3, 2023 at 8:36 AM
Supplemental Information
Amplifies: 173.39, 173.392; 42 U.S.C.3030c-2; 45 C.F.R. 75.403, 1321.11, 1321.53, 1321.65, 1321.67
Five Year Review Date: 11/30/2027
Prior Effective Dates: 5/15/2000, 9/30/2001, 5/16/2005, 2/15/2009, 10/1/2013, 8/1/2016, 6/1/2018, 5/8/2020, 4/4/2022