New Mexico Administrative Code
Title 9 - HUMAN RIGHTS
Chapter 2 - AGE
Part 3 - ELIGIBILITY FOR AGING AND LONG-TERM SERVICES DEPARTMENT SERVICES
Section 9.2.3.12 - COST SHARING AND SLIDING FEE SCALES
Current through Register Vol. 35, No. 6, March 26, 2024
A. In making application to apply cost sharing to services, area agencies on aging and providers must consider the intent of the Older Americans Act to serve targeted populations and must ensure that the application of cost sharing will not prevent the provision of services to low-income, minority, socially isolated, or rural populations. Cost sharing is a process which enables clients to contribute monetarily to the cost of the services they receive. Cost sharing may include the implementation of a sliding fee scale.
B. A fee is defined as a charge allowed by law for a service. A sliding fee scale is a graduated series of fees to be paid based on amount of income. If a sliding fee scale is implemented, area agencies on aging and providers must protect the privacy and confidentiality of older individuals. The individuals to be served must be informed that the service is provided on a fee-for-service basis and be notified of the sliding fee scale.
C. Area agencies on aging shall solicit the views of older individuals, providers, and other stakeholders prior to implementation of cost sharing in each respective service area of the state.
D. Area agencies on aging may contract to purchase services that charge a sliding fee based on income and the cost of delivering services. Such services may include, and, if Older Americans Act funds are used, are limited to:
E. If Older Americans Act funds are used, such services may not include:
F. With regard to any fees charged for Older Americans Act services, determination of a client's fee for a service shall be based on a client's confidential self-declaration of income, and spouse's income (if applicable), without verification. Older Americans Act services may not be denied due to the income of an individual or an individual's failure to make a cost sharing payment.
G. If a sliding fee scale is to be used, a description of the scale -its criteria, policies and payments must be written in language(s) reflecting the reading abilities of older individuals served and posted in high visibility areas. Such posting must include a statement that no services will be denied for failure to pay any fee. Assets, savings, or other property owned may not be considered in determining the fee for a service.
H. Revenues generated by a fee-for-service program must be spent on the same program that generates the funds in order to enhance the program.
I. Appropriate procedures to safeguard and account for cost sharing payments must be established.
J. The basis for a sliding fee scale is to be the U.S. administration on aging's annual issuance of "estimated poverty and near poverty thresholds." "near poverty" is defined as one hundred twenty five percent (125%) of the poverty level. Individuals and families whose income is at or below the near poverty threshold shall not be charged for services.
K. Each and any specific sliding fee scale must be:
L. Fees:
