TITLE
9 HUMAN RIGHTS
CHAPTER
2 AGE
PART 3 ELIGIBILITY
FOR AGING AND LONG-TERM SERVICES DEPARTMENT SERVICES
9.2.3.1 ISSUING AGENCY: New Mexico Aging and Long Term Services Department
(NMALTSD)
[9.2.3.1
NMAC - Rp, SAA Rule No. 95-3.1, 6/30/2015]
9.2.3.2 SCOPE: These rules apply to members of the public
and organizations that participate in the delivery of services to New Mexico’s
aging and disability populations.
[9.2.3.2
NMAC - Rp, SAA Rule No. 95-3.2, 6/30/2015]
9.2.3.3 STATUTORY AUTHORITY: Aging
and Long-Term Services Department Act, Aging and Long-Term Services Department
Act, Sections 9-23-1 to
9-23-12 NMSA 1978; Older
Americans Act of 1965, 42 U.S.C. Sections 3001 to 3058, and implementing
regulations.
[9.2.3.3
NMAC - Rp, SAA Rule No. 95-3.3, 6/30/2015]
9.2.3.4 DURATION: Permanent.
[9.2.3.4
NMAC - Rp, SAA Rule No. 95-3.4, 6/30/2015]
9.2.3.5 EFFECTIVE DATE: June 30, 2015, unless a later date is cited
at the end of a section.
[9.2.3.5
NMAC - Rp, SAA Rule No. 95-3.5, 6/30/2015]
9.2.3.6 OBJECTIVE: The objective of this rule is to establish
standards and procedures for the federal and state-funded programs administered
by the aging and long term services department.
[9.2.3.6
NMAC - Rp, SAA Rule No. 95-3.6, 6 /30/2015]
9.2.3.7 DEFINITIONS: See 9.2.1.7 NMAC for definitions.
[9.2.3.7
NMAC - Rp, SAA Rule No. 95-3.7, 6/30/2015]
9.2.3.8 OLDER AMERICANS ACT SERVICES: Except as otherwise provided, eligibility for
federally-funded supportive services, nutrition services, caregiver services, legal
services, long-term care ombudsman services, employment services, and other
services funded by the Older Americans Act shall be pursuant to the Older
Americans Act and Provisions Governing the Senior Community Service Employment
Program, 20 C.F.R. Section 641, and is incorporated by reference into this
part.
A. Criteria for employment services is set forth in 9.2.13 NMAC.
B. Criteria for legal services is set forth in 9.2.17 NMAC.
C. Criteria for nutrition services is set forth in 9.2.18 NMAC.
D. Criteria for
long-term care ombudsman services is set forth in
9.2.19 NMAC.
[9.2.3.8
NMAC - Rp, SAA Rule No. 95-3.8, 6/30/2015]
9.2.3.9
CORPORATION FOR NATIONAL
SERVICE VOLUNTEER PROGRAMS:
Except as otherwise provided, eligibility for federally-funded foster grandparent,
senior companion, and retired senior volunteer programs shall be pursuant to
Title II, Part B, of the Domestic Volunteer Service Act of 1973, 42 U.S.C.
Sections 4950 to 5028; 45 C.F.R. Sections 2551 to 2553. The corporation for national
and community service (CNCS) handbooks are incorporated by reference
into this part.
A. Criteria for the
foster grandparent program is further set forth in
9.2.14 NMAC.
B. Criteria for the
senior companion program is further set forth in
9.2.15 NMAC.
C. Criteria for the
retired senior volunteer program is further set forth
in 9.2.16 NMAC.
[9.2.3.9
NMAC - Rp, SAA Rule No. 95-3.9, 6/30/2015]
9.2.3.10 STATE-FUNDED SERVICES: Eligibility for programs funded solely with
state funds are as follows:
A. Except where otherwise noted, the following
may be deemed eligible for state-funded services provided under contract with
the department:
(1) Persons
age fifty (50) or older;
(2) Spouses
(of any age) of persons age fifty (50) or older;
(3) Persons
with disabilities age eighteen (18) or older.
B. Criteria for
adult protective services is set forth in 8.11.4 NMAC.
C. Area agencies on aging and other contract
providers may elect to serve subsets of the populations specified in Subsection
D of 9.2.3.10 NMAC, which shall be defined in their area plans and contract
documents.
D. Area agencies on aging and other contract providers may
request waivers from the department to serve additional populations other than
those specified in Subsection A of 9.2.3.10 NMAC, based upon community need. Application for such a waiver shall include a
description of:
(1) The
population(s) to be served;
(2) The
need for the proposed service(s) by the proposed population(s); and
(3) A
budget for the proposed service(s).
Approval of any such waiver will be made by the
department contingent upon documented need and availability of funding. Final or conditional written approval will be
provided by the department.
[9.2.3.10
NMAC - Rp, SAA Rule No. 95-3.10, 6/30/2015]
9.2.3.11 VOLUNTARY CONTRIBUTIONS:
A. The Older Americans Act establishes
requirements for voluntary contributions.
Each older person who receives Older Americans Act-funded services shall
be provided an opportunity to voluntarily contribute to the cost of services
rendered.
B. Area agencies on
aging and other programs are allowed to, and may solicit, voluntary
contributions for all Older Americans Act-funded services, provided that the
method of solicitation is non-coercive. Each service provider may develop a
suggested contribution schedule for services provided with Older Americans Act
funds. In developing such a schedule,
the provider shall consider the income ranges of older persons in the
provider’s community, as well as the provider’s other sources of income.
C. Area agencies on
aging and providers shall not means test for any service for which
contributions are accepted, or deny services to any individual who does not
contribute.
D. Each area agency
on aging shall consult with its relevant service providers and older
individuals in its planning and service area(s) to determine the best method(s)
for accepting voluntary contributions.
E. Area agencies on
aging and programs shall:
(1) Establish
policies and procedures for soliciting, safeguarding, and accounting for
contributions;
(2) Protect
the privacy of each person with respect to his/her contribution, or lack of
contribution;
(3) Clearly
inform each person that there is no obligation to contribute, and that contribution
is voluntary;
(4) Fully
describe the contribution policy in the area plan or in a provider’s program
plan;
(5) Use
any collected contributions to expand the service(s) for which the
contributions were given; and
(6) Post information
regarding any suggested contributions at the service premises in a location
convenient to the participants.
[9.2.3.11
NMAC - Rp, SAA Rule No. 95-3.11, 6/30/2015]
9.2.3.12
COST SHARING AND SLIDING FEE
SCALES:
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:
(1) Transportation/assisted
transportation;
(2) Shopping assistance;
(3) Homemaker/housekeeping;
(4) Adult day care/day
health care;
(5) Personal care;
(6) Home health;
(7) Respite care;
(8) Home repair;
(9) Chores;
(10) Escort;
(11) Recreation;
(12) Physical
fitness/exercise;
(13) Education/training;
(14) Home
safety/accident prevention.
E. If Older Americans Act funds are used, such
services may not include:
(1) Information
and assistance;
(2) Outreach;
(3) Benefits
counseling;
(4) Case
management;
(5) Ombudsman
services;
(6) Consumer
protection services;
(7) Congregate
meals;
(8) Home
delivered meals;
(9) Legal
assistance;
(10) Elder
abuse prevention;
(11) Any
services delivered through tribal organizations.
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:
(1) Reviewed and approved by the department;
(2) Reviewed in a public hearing prior to
implementation. The department may grant
short-term approval prior to a public hearing to test the concept;
(3) Fully described by an area agency on aging in
its area plan;
(4) Implemented based on established policies and
procedures. These policies and
procedures must address the circumstances that allow the provider to waive the
fee-for-service and also address when an individual’s or family’s net income
may be considered rather than gross income.
L. Fees:
(1) Are to be based on the actual cost of
providing a service (as determined by a program, submitted to an area agency on
aging and approved by the department).
(2) Cannot exceed the actual cost of providing a
service.
[9.2.3.12
NMAC - Rp, SAA Rule No. 95-3.12, 6/30/2015]
HISTORY
OF 9.2.3 NMAC:
Pre-NMAC History: The material in this part was derived from
that previously filed with the State Records Center:
SAA
Rule No. 95-3, Eligibility for State Agency on Aging Services, filed 4/13/95.
History of
Repealed Material:
SAA
Rule No. 95-3, (filed 4/13/1995) - Repealed 6/30/2015.