Cost Sharing

(1) Voluntary Co-payments. (a) Consumers who are eligible for the Frail Elder Home and Community Based Services Waiver shall not be informed of the option to make Voluntary Co-payments for services, including without limitation, home delivered meals. (b) Elders whose gross annual income does not exceed the amounts set forth in the Voluntary Co-payment section of the Financial Eligibility Guidelines shall be requested to make a Voluntary Co-payment toward the cost of Home Care Program Services provided in accordance with the schedule set forth therein. (c) An ASAP may not deny an individual who is eligible under 651 CMR 3.04 and 3.06(1)(b) for Home Care Program Services because he or she will not make a Voluntary Co-payment. (d) ASAPs shall not accept Voluntary Co-payments in excess of the cost of the Client's services. (e) ASAPs shall maintain separate accounts for Voluntary Co-payments collected under 651 CMR 3.06(1(b) and Co-payments collected under 651 CMR 3.06(2)(b) and (c) and shall report such collections in a manner determined by Elder Affairs. (f) MassHealth members with any coverage type whose income is at or below 300% of the Supplemental Security Income Federal Benefit Rate (SSI FBR) are exempt from all co-payments, including Voluntary Co-payments. (2) Co-payments. (a) Income of an Applicant or Consumer described in 651 CMR 3.06(1)(f) shall be verified by the ASAP through the MassHealth verification system. The ASAP shall record the MassHealth number as required in the Consumer's electronic record. (b) Individuals who are not financially eligible pursuant to 651 CMR 3.06(1), whose income falls into the Home Care Services Co-payment schedule set forth in the Financial Eligibility Guidelines shall be assessed a co-payment for Home Care Program Services based on the schedule set forth therein in effect on the date of his or her initial determination or re-determination of financial eligibility as defined in 651 CMR 3.04(4)(h). (c) If a Consumer's income is within the range noted in the Home Care Cost Sharing schedule and is in need of and eligible for Home Care Services, the following Co-payment Schedule shall be used: 1. The monthly Co-payments shall be determined according to the Home Care Cost Sharing income schedule set forth in the Financial Eligibility Guidelines in effect during his or her initial determination or re-determination of financial eligibility as defined in 651 CMR 3.04(4)(h). 2. Payment of such Copayment shall be agreed upon by the Consumers indicated on forms provided by Elder Affairs. 3. Copayments shall not be collected in excess of the cost of Home Care Services. (d) Co-payments for Home Delivered Meals for Non-waiver Consumers. 1. Home Delivered Meals may be provided on a per meal co-payment at a rate set at the same level as the suggested contribution of the Title III-C nutrition program within the area served by the ASAP, and shall not exceed the cost of the meal. 2. Co-payments may be collected and retained by the Home Delivered Meals provider. Nutrition providers not subject to Title IIIC requirements shall not collect co-payments. 3. Home Delivered Meals shall not be denied for failure to pay the Co-payment for this service. (e) Billing of Co-payments. 1. The ASAP shall provide a monthly bill for each Consumer for the Co-payment as determined in 651 CMR 3.06(2)(b) or (c). The Co-payment shall be due within 30 days of the date of the bill. The ASAP shall make all reasonable efforts to collect Co­ payments. ASAPs may undertake action to enforce payment of said Co-payment up to and including termination of services. ASAPs shall have the ability to waive or reduce Co-payments based on hardships that impact the Consumer's ability to pay. 2. If all or part of a Consumer's Co-payment becomes two or more months overdue after the ASAP has made all reasonable efforts to collect the Co-payment, the ASAP may send a Notice of Action to the Consumer. If the Consumer fails to pay the Co-payment or to establish a payment schedule within 14 days after receipt of the Notice of Action, the ASAP may terminate services to the Consumer. An ASAP may send a Notice of Action to terminate services for reasons of non-payment to a Protective Services client receiving Home Care Services only if it complies with the procedures established in 651 CMR 3.07. 3. When an ASAP terminates Home Care Program Services due to the failure of a Consumer to pay the Co-payment, such Consumer may reapply and receive Home Care Program Services provided that he or she pays all past due Co-payments or agrees to a schedule of repayment of such past due amounts. 4. ASAPs shall use retained Co-payments collected to provide Home Care Program Services to Consumers. 5. ASAPs shall maintain separate accounts for Voluntary Co-payments collected under 651 CMR 3.06(1), and Co-payments collected under 651 CMR 3.06(2)(b) and (c), and shall report such collections in a manner determined by Elder Affairs.