Department of Health and Human Services


OFFICE OF 

INSPECTOR GENERAL 

COST SHARING FOR OLDER 


AMERICANS ACT SERVICES


Daniel R. Levinson


Inspector General 


September 2006


OEI-02-04-00290

Office of Inspector General 
 http://oig.hhs.gov 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, 

as amended, is to protect the integrity of the Department of Health and Human Services 

(HHS) programs, as well as the health and welfare of beneficiaries served by those 

programs. This statutory mission is carried out through a nationwide network of audits, 

investigations, and inspections conducted by the following operating components: 

Office of Audit Services 

The Office of Audit Services (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by 

others. Audits examine the performance of HHS programs and/or its grantees and 

contractors in carrying out their respective responsibilities and are intended to provide 

independent assessments of HHS programs and operations. These assessments help 

reduce waste, abuse, and mismanagement and promote economy and efficiency 

throughout HHS. 

Office of Evaluation and Inspections 

The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide 

HHS Congress, and the public with timely, useful, and reliable information on 

significant issues. Specifically, these evaluations focus on preventing fraud, waste, or 

abuse and promoting economy, efficiency, and effectiveness in departmental programs. 

To promote impact, the reports also present practical recommendations for improving 

program operations. 

Office of Investigations 

The Office of Investigations (OI) conducts criminal, civil, and administrative 

investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries 

and of unjust enrichment by providers. The investigative efforts of OI lead to criminal 

convictions, administrative sanctions, or civil monetary penalties. 

Office of Counsel to the Inspector General 

The Office of Counsel to the Inspector General (OCIG) provides general legal services to 

OIG rendering advice and opinions on HHS programs and operations and providing all 

legal support in OIG' s internal operations. OCIG imposes program exclusions and civil 

monetary penalties on health care providers and litigates those actions within HHS. 

OCIG also represents OIG in the global settlement of cases arising under the Civil False 

Claims Act, develops and monitors corporate integrity agreements, develops compliance 

program guidance, renders advisory opinions on OIG sanctions to the health care 

community, and issues fraud alerts and other industry guidance. 
Δ EXECUTIVE SUMMAR Y 

OBJECTIVES 

To assess the extent to which States have implemented cost sharing 

under the Older Americans Act (OAA). 

To determine whether States implementing cost sharing under the OAA 

do so in accordance with requirements designed to protect low-income 

individuals’ access to services. 

BACKGROUND 

The Administration on Aging (AoA) has asked the Office of Inspector 

General to assess States’ implementation of cost sharing. In 2000, 

amendments to the OAA allowed States to implement cost sharing for 

certain OAA services. Cost sharing provides a mechanism for States to 

expand services to a growing number of Americans 60 years of age and 

older. However, there is a general concern that cost sharing could 

negatively impact participation of certain individuals, particularly those 

with low incomes. This study is intended to provide relevant 

information to AoA and to Congress as they consider any changes to cost 

sharing during the current reauthorization of the OAA. 

The OAA was enacted in 1965 and authorized a range of social service 

and nutrition programs. It also created AoA, which carries out its 

responsibilities by coordinating with State Units on Aging (State Units), 

Area Agencies on Aging (area agencies), tribal organizations, and local 

service providers. AoA distributes funds to States through Title III, 

Grants for State and Community Programs on Aging. Title III-B funds 

supportive services, Title III-C funds nutrition services, Title III-D 

funds disease prevention services, and Title III-E funds the National 

Family Caregiver Support Program. 

The amendments to the OAA include a number of requirements for 

States that choose to implement cost sharing. These requirements are 

intended to ensure that low-income older individuals can obtain 

services. Pursuant to the OAA, States and area agencies must develop 

cost-sharing plans. The OAA further provides that States require area 

agencies and local service providers to exclude individuals with incomes 

at or below the Federal poverty line from cost sharing; not deny services 

to individuals who do not pay; account for payments; and inform 

recipients about cost sharing. Also, States must establish sliding scales 

for cost sharing based on income. Additionally, AoA must determine the 

impact of cost sharing on participation rates. 

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EXE CUTIVE S U MMAR Y 

This study looks at the extent to which States have implemented cost 

sharing and whether they have implemented it in accordance with 

statute requirements. We based this study on data gathered from 

multiple sources: a written survey completed by State Unit 

representatives from all 50 States, Puerto Rico, and the District of 

Columbia; a review of relevant State documents regarding cost sharing 

implementation, program revenue, and participation; structured 

interviews with State Unit representatives, area agency officials, and 

State data officials; and a review of AoA’s National Aging Program 

Information System/State Program Reports (NAPIS/SPR) and 

individual State data. AoA collects participation data for many of the 

OAA services through the NAPIS/SPR. AoA uses the NAPIS/SPR data 

to plan and manage activities performed and services provided under 

the OAA. 

FINDINGS 

States’ implementation of cost sharing for OAA services is limited. 

Twelve States have implemented cost sharing for at least one OAA 

service. None of these States has implemented cost sharing for all OAA 

services for which cost sharing is allowed. Further, in at least 6 of the 

12 States, fewer than 350 individuals participate in cost sharing in each 

of these States. 

The States that have implemented cost sharing do not always follow 

OAA requirements for cost sharing that are designed to protect lowincome individuals’ access to services. The States that have 

implemented cost sharing do not always follow key OAA requirements. 

Nine States have not developed cost-sharing plans to ensure that the 

participation of low-income individuals receiving services will not 

decrease with the implementation of cost sharing. Five States permit 

individuals with incomes at or below the Federal poverty line to cost 

share. Six States either deny services to individuals who do not pay or 

make cost sharing appear mandatory. Three States have not 

established sliding scales as required by the OAA. Six States do not 

have policies for accounting for cost-share payments. Finally, none of 

the States has created the required written materials that explain cost 

sharing to recipients. 

AoA has provided limited guidance to States and State officials are 

often confused about features of cost sharing under the OAA. AoA 

has provided limited guidance to States on implementing cost sharing in 

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EXE CUTIVE S U MMAR Y 

accordance with the OAA. AoA conducted an initial training session for 

its regional offices. However, the training did not cover key 

requirements such as the plans States are required to develop and the 

written materials that explain cost sharing that States must create. In 

addition, we found that AoA officials have limited information about 

how States are implementing cost sharing. For instance, they have 

little knowledge about States’ plans regarding cost sharing, their sliding 

scales, accounting for cost-share payments, or informing recipients 

about cost sharing. Finally, we found that officials from States and area 

agencies often are confused about cost sharing for OAA services. 

AoA’s participation data cannot be used to determine the impact of 

cost sharing on participation rates. AoA is required to conduct an 

annual evaluation of cost sharing to determine its impact on the 

participation rates of individuals targeted by the OAA. AoA collects 

participation data for many OAA services through the NAPIS/SPR. We 

found that States report data in the NAPIS/SPR differently and that the 

demographic data in the NAPIS/SPR are incomplete. As a result, data 

in the NAPIS/SPR do not present a complete picture of participation 

and, therefore, cannot be used to measure any impact cost sharing 

might have on overall participation or on participation of low-income 

individuals and other subgroups specified in the OAA. 

RECOMMENDATIONS 

Based on these findings, we recommend that AoA: 

Ensure that States’ cost-sharing practices comply with requirements 

designed to protect low-income individuals’ access to services. AoA 

should address State and area agency practices that permit low-income 

individuals to participate in cost sharing. AoA should also address 

State and area agency practices that deny services to older individuals 

due to income or failure to make a cost-share payment, as well as 

practices that make cost sharing appear mandatory. In addition, AoA 

should address the States’ lack of cost-sharing plans, sliding fee scales, 

policies for accounting for payments, and written material that explain 

cost-sharing. 

Provide additional guidance to States about implementing cost 

sharing in accordance with the OAA. AoA should provide additional 

guidance to States regarding how to implement cost sharing in 

accordance with OAA requirements. The guidance should address 

issues such as (1) developing plans to ensure that the participation of 

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EXE CUTIVE S U MMAR Y 

low-income individuals will not decrease with the implementation of cost 

sharing; (2) excluding low-income individuals from cost sharing; 

(3) prohibiting the denial of services; (4) establishing sliding scales; 

(5) developing procedures to account for cost-sharing payments; and 

(6) preparing written materials to inform recipients about cost sharing. 

AoA should also develop additional strategies to keep States informed 

about these issues. 

Improve the quality of the NAPIS/SPR data so that any effects of 

cost sharing can be measured. AoA should improve the quality of its 

data to measure any future impacts cost sharing may have on 

participation rates, as required by the OAA. During the course of this 

study, AoA has addressed some of the data problems. Specifically, the 

NAPIS/SPR now retains records with missing data elements; the 

NAPIS/SPR now collects some demographic data for recipients of Title 

III-E services; and AoA is no longer required to approve waivers to 

States. However, AoA has not addressed the differences in State 

reporting. 

When addressing these differences, AoA needs to give clear and 

consistent instructions to States and consider whether to continue 

directing States to report information for all services, including those 

funded solely by State or local entities. If the NAPIS/SPR includes data 

about non-OAA-funded services, then AoA needs to consider how it will 

determine any effects of cost sharing on participation in OAA programs 

and services, as required by the OAA. 

In addition, the inconsistency of AoA’s participation data has 

implications beyond cost sharing. This study focuses only on cost 

sharing, but the differences in data reporting raise questions regarding 

how AoA can use the data to effectively plan and manage activities 

funded under the OAA. This broader issue affects AoA’s capacity to 

manage all aspects of these services, not only cost sharing. 

AGENCY COMMENTS 

AoA provided comments on the draft report. In general, AoA agrees 

with our findings that cost sharing is limited and that States are 

confused about cost sharing. AoA states that it has taken many steps to 

educate the Aging Network on cost sharing and does not agree with our 

finding that it has provided limited guidance to States. AoA also states 

that our observations about NAPIS/SPR are outside the scope of the 

study and that it has made several improvements to NAPIS/SPR over 

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EXE CUTIVE S U MMAR Y 

the last 5 years. In response to our recommendations, AoA notes that it 

will follow up on our observations and correct instances of 

noncompliance with the provisions of the OAA. AoA also plans to 

provide additional guidance to States on an ongoing basis and post more 

information on its Web site. 

OFFICE OF INSPECTOR GENERAL RESPONSE 

Where appropriate, we have made changes to the report based on AoA’s 

comments. 

Because the OAA requires AoA to determine the impact of cost sharing 

on participation rates, and NAPIS/SPR is the only data AoA has on 

participation, we believe that it is necessary to include NAPIS/SPR in 

any discussion about whether cost sharing has had an impact on 

participation rates. 

We recognize that AoA has made several improvements to NAPIS/SPR 

over the last 5 years, many of which are noted in the report. However, 

despite these improvements, we found that the States that cost share 

report participation data in the NAPIS/SPR differently and include 

different populations in their counts. This issue is important because it 

has potential implications beyond cost sharing. These data provide 

essential information for AoA, including performance outcome 

information required by the Government Performance and Results Act 

and the Performance Assessment Rating Tool. 

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Δ T ABLE OF CONTENTS 

EXECUTIVE SUMMARY ..................................... i

INTR O D U C T I ON ........................................... 1

FINDI NGS ................................................. 8

States’ implementation of cost sharing limited ................ 8

States do not always follow key OAA requirements ........... 10

AoA has provided limited guidance to States ................ 13

AoA’s data cannot be used to determine impact .............. 15

RECOM M E NDATI O NS ..................................... 18

 Agency Comments...................................... 19

Office of Inspector General Response....................... 19

APPENDIXES ............................................. 21

 Agency Comments...................................... 21

ACKN O W LEDGMENTS .................................... 42
Δ INTRODU C TION 

OBJECTIVES 

To assess the extent to which States have implemented cost sharing 

under the Older Americans Act (OAA). 

To determine whether States implementing cost sharing under the OAA 

do so in accordance with requirements designed to protect low-income 

individuals’ access to services. 

BACKGROUND 

The Administration on Aging (AoA) has asked the Office of Inspector 

General (OIG) to assess States’ implementation of cost sharing. The 

year 2000 amendments to the OAA allowed States to implement cost 

sharing for certain OAA services. AoA defines cost sharing as a method 

of allowing a recipient to share in the cost of the service received. Cost 

sharing provides a mechanism for States to expand services to a 

growing number of Americans 60 years of age and older. However, 

there is general concern that cost sharing could negatively impact 

participation of certain individuals, particularly those with low 

incomes. 

This study looks at the extent to which States have implemented cost 

sharing and whether they have implemented it in accordance with the 

OAA. It is intended to provide relevant information to AoA and to 

Congress as they consider any changes to cost sharing during the 

current reauthorization of the OAA. 

The Older Americans Act 

The OAA was enacted in 1965 to improve the quality of life for older 

individuals. It created AoA and authorized a range of social service and 

nutrition programs. AoA distributes funds to States through Title III, 

Grants for State and Community Programs on Aging. The funds under 

Title III are divided as follows: 

o Part B funds supportive services, such as transportation, personal 

care, homemaker, chore, adult day care, and legal assistance. 

o Part C funds nutrition services, such as congregate and homedelivered meals and nutrition education. 

o Part D funds disease prevention and health promotion services. 

o Part E funds the National Family Caregiver Support Program, 

which was created in 2000 to provide services to family caregivers. 

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INTROD UCT ION 

These services include respite care to temporarily relieve caregivers 

from their responsibilities, as well as supplemental services which 

complement the care provided by caregivers and include such 

services as home modifications, emergency response systems, and 

transportation. 

States’ allotments are based on the number of residents 60 years and 

older. All older individuals are eligible to receive OAA services, but 

States must assure that preference is given to those in greatest 

economic or social need, particularly minority older individuals and 

older individuals residing in rural areas. 

The Administration on Aging 

AoA administers the grants under the OAA. AoA carries out its 

responsibilities by coordinating with State Units on Aging (State Units), 

Area Agencies on Aging (area agencies), tribal organizations, and local 

service providers. AoA is required under the OAA to provide technical 

assistance and consultation to States with respect to programs for older 

individuals.1 In 2004, AoA’s budget was $1.37 billion. AoA has 

10 regional offices that assist States in serving the older population. 

Each State and U.S. Territory has a State Unit. It is “primarily 

responsible for the planning, policy development, administration, 

coordination, priority setting, and evaluation of all State activities 

related to the objectives of this Act.”2 Most State Units divide the State 

into planning and service areas and designate a public or private 

nonprofit agency or organization as the area agency for each area. 

These agencies develop and implement area plans for their respective 

planning and service area. Some smaller States, such as Delaware and 

Rhode Island, are not divided into planning and service areas and do 

not have area agencies. 

Cost Sharing Amendments to the Older Americans Act 

Amendments to the OAA in 2000 allow States to cost share for certain 

services under Title III. Prior to 2000, States were not allowed to 

charge fees to individuals using services funded by the OAA.3 However, 

States were allowed to solicit and collect voluntary contributions from 

recipients of OAA services. 

1 42 U.S.C. § 3012(a)(6). 

2 42 U.S.C. § 3025(a)(1)(c).

3 States were allowed to charge fees to recipients of State or locally funded services. 

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As stated in the year 2000 amendments, States are allowed to 

implement cost sharing for all services except for those explicitly 

excluded.4 Services that States are allowed to cost share include, but 

are not limited to, Part B personal care, homemaker, chore, adult day 

care, assisted transportation, and transportation; Part D disease 

prevention and health promotion; and Part E respite and supplemental 

services. 

Requirements for States that Cost Share 

The OAA places a number of requirements on States that choose to 

implement cost sharing.5 These requirements are intended to ensure 

that cost sharing does not discourage low-income older individuals from 

obtaining services. Key components of these requirements are listed 

below. 

Development of plans. The OAA requires States and area agencies to 

develop plans before implementing cost sharing. These plans should be 

designed to ensure that the implementation of cost sharing will not 

decrease the participation of low-income older individuals (with 

particular attention to low-income minority individuals and older 

individuals residing in rural areas) receiving OAA services. 

Exclusion of low-income older individuals. States may not permit cost 

sharing by individuals with incomes at or below the Federal poverty 

line. 

No denial of services. States must require that area agencies and local 

service providers not deny services to an older individual due to the 

individual’s income or the individual’s failure to make a cost-share 

payment. 

Sliding scales. States are required to establish a sliding scale based 

solely on individual income and the cost of delivering services. States 

cannot consider any assets, savings, or other property owned by older 

individuals when creating their sliding scales. 

Accounting and use of cost-share payments. States must ensure that area 

agencies and service providers establish appropriate procedures to 

safeguard and account for cost-share payments. States also must 

4 The year 2000 amendments specifically state that certain services, such as information 

and assistance, outreach, elder abuse prevention, and meals, are excluded from cost 

sharing. 

5 42 U.S.C. § 3030c-2. 

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require area agencies and service providers to use collected cost-share 

payments to expand the service for which the payments were given. 

Informing recipients. States must create written materials that explain 

the criteria for cost sharing, the sliding scale, and the stipulation that 

services cannot be denied to an older individual due to income or failure 

to make a cost-share payment. States must require the area agencies 

and service providers to widely distribute the written materials. 

The area agencies in States that implement cost sharing may request a 

waiver to the State’s cost sharing policies when a significant proportion 

of individuals receiving services in the area have incomes below the 

threshold established by the State or when cost sharing poses an 

unreasonable administrative or financial burden on the area agency. 

The OAA also requires AoA to conduct a comprehensive evaluation of 

cost sharing to determine its impact on participation rates. This 

evaluation should be conducted no later than 1 year after the 

enactments of the year 2000 amendments to the OAA and annually 

thereafter. AoA must take corrective action if it finds cost sharing has 

had a disparate impact upon low-income or minority older individuals or 

older individuals residing in rural areas.6 

National Aging Program Information System and State Performance Reports 

AoA collects participation data for many OAA services through the 

National Aging Program Information System/State Performance 

Reports (NAPIS/SPR). The NAPIS/SPR contains overall participation 

and demographic data for certain Title III-B services such as personal 

care, homemaker, chore, adult day care, and assisted transportation 

services. For services under Title III-E, the National Family Caregiver 

Support Program, the NAPIS/SPR includes participation data but not 

demographic data. The NAPIS/SPR does not contain any data on the 

number of people participating in cost sharing for any of these services. 

AoA uses the NAPIS/SPR data to plan and manage activities performed 

and services provided under the OAA. 

The State Units gather data from their area agencies and then submit 

the data to AoA. Some States and area agencies collect additional 

information on participation not required for the NAPIS/SPR. For 

example, an area agency may collect demographic data on recipients of 

6 42 U.S.C. § 3030c-2(d). 

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caregiver support services. AoA conducts a number of checks on the 

data that States submit to the NAPIS/SPR. 

Prior Studies 

OIG conducted two studies about cost sharing for AoA prior to the year 

2000 amendments to the OAA. The first report in October 1990, “Cost 

Sharing for Older Americans” (OEI-02-90-01010), assessed States’ 

experiences with State programs for older individuals that provided 

services on a cost-sharing basis. It found that recipients responded 

positively to cost sharing, cost sharing was seen as effective and 

efficient, and extending cost sharing to Title III had strong support. 

The second report in May 1996, “Cost Sharing Under the Older 

Americans Act” (OEI-05-95-00170), described States’ practices of cost 

sharing for State services and discussed potential implementation 

issues for the expansion of cost sharing to OAA services. This study 

found that 36 States reported having some kind of cost-share program 

for at least 1 State-funded service for older individuals. States varied 

greatly in terms of which services they cost shared, and how 

responsibilities were distributed among the State Units, area agencies, 

and service providers. The study also stated that AoA needed to pay 

special attention to fee schedules, income declaration and verification, 

billing and collection activities, and policies on payment default before 

cost sharing is implemented. 

METHODOLOGY 

We based this study on data gathered from multiple sources: a written 

survey completed by State representatives from all 50 States, Puerto 

Rico, and the District of Columbia; a review of relevant State documents 

regarding cost-sharing implementation, program revenue, and 

participation; a review of the NAPIS/SPR and individual State data; 

and structured interviews with State Unit representatives, area agency 

officials, and State data officials. For the purposes of this report, we 

refer to the District of Columbia and Puerto Rico as States. 

Scope 

This study focuses on States’ implementation of cost sharing for OAAfunded services. This study does not include States’ experiences in 

implementing voluntary contributions for OAA services or their 

experiences in implementing cost sharing for State-funded services. 

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INTROD UCT ION 

This study addresses Part B and Part E and does not address Part D. 

Initial research indicated that cost sharing for Part D was rarely, if 

ever, used. Part C services are excluded from cost sharing. 

Written State Survey 

We conducted a written survey of State Unit representatives from all 

50 States, Puerto Rico, and the District of Columbia to identify the 

States that have implemented cost sharing for services funded by the 

OAA. We received responses from all. As discussed below, we reviewed 

documentation from each State reporting cost sharing to verify their 

responses. 

Document Review 

We reviewed all cost-sharing plans, policies, and procedures for the 

States that have implemented cost sharing. We identified the services 

that are cost shared. We also determined how each State has 

implemented cost sharing and has addressed the requirements for 

States that choose to cost share. We focused our review on how States 

determine eligibility; establish sliding scales; collect, account for, and 

use payments; and inform recipients. We also reviewed relevant 

financial and service reports from States and area agencies, when 

available, and any written materials States and area agencies use to 

explain cost sharing to recipients. Finally, we reviewed training 

materials produced by AoA and information from AoA’s Web site. 

NAPIS/SPR and State Data 

We analyzed all available participation data from the NAPIS/SPR for 

each of the cost-sharing States. As noted earlier, the NAPIS/SPR 

contains statewide participation data for OAA services. It does not 

contain the number of individuals participating in cost sharing. We also 

collected and analyzed all available participation data for cost-shared 

services from each of the States, including available area agency data. 

Structured Interviews with State and Area Agency Officials 

We conducted structured interviews with officials from the State Units 

in each of the cost-sharing States. We focused our discussions on the 

services that are cost shared and how the State and area agencies have 

implemented cost sharing for these services. We paid particular 

attention to how each State has addressed the requirements regarding 

eligibility, sliding scales, accounting for payments, and informing 

recipients about cost sharing. We also discussed any guidance the State 

has provided to its area agencies. We conducted 12 interviews from 

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February to March 2005. In this study, we refer to the State Unit 

representatives we interviewed as “State officials.” 

We also conducted structured interviews with area agency officials from 

a purposive sample of area agencies in the States that have 

implemented cost sharing. We interviewed officials from all costsharing area agencies in States that had three or fewer cost-sharing 

area agencies. We interviewed officials from three selected cost-sharing 

area agencies in States that had more than three cost-sharing agencies. 

We selected the area agencies based on States’ estimates of the number 

of people participating in cost sharing. Specifically, we selected one 

area agency with high participation, one in the middle, and one with low 

participation. The interviews focused on the area agencies’ experiences 

with implementing cost sharing for OAA services. In total, we 

interviewed officials from 21 area agencies. We conducted these 

interviews from March to May 2005. 

We also conducted structured interviews with data officials from all cost 

sharing States to determine what types of data States report to the 

NAPIS/SPR. These interviews were conducted from May to June 2005. 

Standards 

Our review was conducted in accordance with the “Quality Standards 

for Inspections” issued by the President’s Council on Integrity and 

Efficiency and the Executive Council on Integrity and Efficiency. 

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Δ FINDINGS

Twelve States have implemented cost 

sharing 

States’ implementation of cost sharing for OAA 

services is limited 

Twelve States have implemented 

cost sharing for at least one OAA service in at least one part of their 

State. These 12 States are Alabama, Arizona, Arkansas, Delaware, 

District of Columbia, Michigan, Minnesota, Montana, Ohio, Puerto Rico, 

Rhode Island, and Virginia. The 12 States receive approximately 

$97.5 million through Title III-B and Title III-E, which is about 

19 percent of Title III-B and Title III-E total grant dollars.7 

Half of these 12 States have implemented cost sharing in all or nearly 

all areas of their State.8 Two other States have implemented it in only 

one area agency in their State, while the remaining four States have 

implemented it in about half of their area agencies. 

None of the 12 States has implemented cost sharing for all allowed OAA 

services 

None of the 12 States has implemented cost sharing for all OAA services 

for which cost sharing is allowed. Eight of the twelve States each cost 

share for one or two different OAA services. The other 4 States each 

cost share for between 6 and 11 different services. 

States most commonly cost share for respite services, homemaker 

services, or supplemental services. Table 1 lists the Title III-B and Title 

III-E services that are cost shared, as well as the number of States and 

area agencies cost sharing for them. Nine States cost share for respite 

services, which offer temporary relief for caregivers. Five States cost 

share for homemaker services and five States cost share for 

supplemental services, which complement the care provided by 

caregivers. Multiple States and area agencies also cost share for adult 

day care, chore, personal care, and transportation. 

7 Calculations used fiscal year 2004 Final Allocation for Title III – Grants for State and 

Community Programs on Aging. 

8 Note that 3 of the 12 States do not have area agencies. These States are the District of 

Columbia, Delaware, and Rhode Island. 

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F I NDING S 

Cost-Shared 

Services Funded by 

Titles III-B and III-E

Table 1: Cost-Shared Services Funded by Titles III-B and III-E 

Title III-B 

Service 

Homemaker 

Number of States that 

Cost Share for Service 

5* 

Number of Area Agencies 

that Cost Share for Service 

31 

Adult Day Care 5* 19 

Chore 5 16 

 Personal Care 3 27 

 Transportation 3 13 

 Home Maintenance/Repair 3 14 

 Medical Assessment 1 8 

 Care/Medication Management 1 3 

 Assisted Transportation 1 5 

 Visiting 1 1 

Socialization/Recreation 1 1 

 Respite III-B 1 1 

Title III-E Respite III-E 9** 50 

 Supplemental Services 5* 23 

Counseling 3 3 

Adult Day Care 1 4 

 Safety Services 1 2 

 Transportation 1 2 

 Assisted Transportation 1 1 

* Includes one State that does not have area agencies. 

 ** Includes two States that do not have area agencies. 

Source: Office of Inspector General analysis of State and area agency documents and interviews, 2005. 

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F I NDING S 

Six of the twelve States report limited participation in cost sharing 

The number of people participating in cost sharing is limited in at least 

six States. Officials from 3 States each estimate having 55 or fewer 

individuals who participate in cost sharing, and officials from 2 more 

States each estimate having about 350 individuals who participate in 

cost sharing.

9 An official from a sixth State could not give an estimate 

for the number of individuals cost sharing statewide, but AoA data 

indicate that it could not be high. This State cost shares for only 

1 service and the total participation for that service is about 

130 individuals. 

The other six States likely have higher numbers of individuals cost 

sharing. These States are larger and cost share for more services in 

more areas of their States. An official from 1 of these States estimates 

that a total of 1,878 individuals participate in cost sharing statewide. 

Officials from the other five States could not provide estimates. 

The States that have implemented cost sharing 

do not always follow OAA requirements for cost 

sharing that are designed to protect low-income 

individuals’ access to services 

The States and area agencies that 

have implemented cost sharing do 

not always follow key OAA 

requirements that are intended to 

ensure that individuals with low 

incomes can obtain OAA services. Table 2 presents the number of costsharing States that have practices that conflict with key requirements. 

9 Statewide counts may be duplicative because recipients may be receiving multiple 

services. 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 10 
F I NDING S 

Table 2: Cost-Sharing States with Practices Not in Accordance with the OAA Requirements 

Cost-Sharing States State or Area Agency 

Practice 

A B C D E F G H I J K L Total 

Has not developed costsharing plan that 

addresses participation 

of low-income individuals 

X X X X X X X X X 9 

Permits individuals with 

incomes at or below the 

Federal poverty level to 

cost share 

X X X X X 5 

Denies services or 

makes cost sharing 

appear mandatory 

X X X X X X 6 

Has not developed a 

sliding scale for all 

services 

X X X 3 

Does not have a policy 

for accounting of costshare payments 

X X X X X X 6 

Has not created written 

materials that explain 

cost sharing 

X X X X X X X X X X X X 12 

Source: Office of Inspector General analysis of State and area agency documents and interviews, 2005. 

Nine States have not developed cost-sharing plans that address the 

participation of low-income individuals 

The OAA requires States and area agencies to develop plans prior to 

implementing cost sharing. These plans should be designed to ensure 

that the implementation of cost sharing will not decrease the 

participation of low-income older individuals receiving OAA services.10 

Four of the twelve States have not developed any plans that address 

cost sharing. Five more States have cost-sharing plans or policies but 

they do not specifically address the participation of low-income 

individuals. The remaining three States have policies that specifically 

state that their respective cost-sharing program is designed to ensure 

that participation of low-income individuals will not decrease. 

10 42 U.S.C. § 3030c-2(c)(2). 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 11 
F I NDING S 

Five States permit individuals with low incomes to cost share 

The OAA prohibits States from permitting cost sharing by individuals 

with incomes at or below the Federal poverty line.11 However, five 

States permit individuals with incomes below the Federal poverty line 

to cost share. Specifically, four States have fee schedules indicating 

that individuals with incomes at or below the Federal poverty line are 

expected to make cost-share payments. Another State excludes these 

individuals from participating in cost sharing for one OAA service in the 

State but not for another. 

Half of the 12 States either deny services or make cost sharing appear 

mandatory 

Pursuant to the OAA, States that cost share must require that area 

agencies and local service providers not deny an older individual 

services due to income or failure to make a cost-share payment.12 

However, two States deny services due to an individual’s income or 

failure to make a cost-share payment. An area agency in one State has 

a policy to suspend services when payments are not made. An official 

from another State reports that the practice in her State is to deny 

services when recipients do not pay, although exceptions are sometimes 

made. 

An additional four States have collection methods that make cost 

sharing appear mandatory. In these States, recipients sign cost-sharing 

agreements. The agreements contain phrases such as “payment 

required” and “bills are due” and do not explain that services will not be 

denied for nonpayment. One area agency calls the cost-share payment a 

“copayment.” This agency also bills the recipient if he or she misses a 

scheduled service. 

Three States have not established sliding fee scales for all of their costshared services 

The OAA requires States that cost share to establish a sliding scale to 

determine payment rates.13 One State has not developed any scales. 

The official from this State says she was not aware that States were 

allowed to develop such scales. In this State, recipients are not charged 

for the first year of service. They are charged half the cost for the 

second year of service and the entire cost thereafter. Two other States 

11 42 U.S.C. § 3030c-2(a)(3). 

12 42 U.S.C. § 3030c-2(a)(5)(E). 

13 42 U.S.C. § 3030c-2(a)(4). 

OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 12 
F I NDING S 

use a sliding scale for some, but not all, of OAA services for which they 

cost share. 

Half of the 12 States do not have policies for the accounting of cost-share 

payments 

Pursuant to the OAA, States that cost share must ensure that area 

agencies and service providers establish appropriate procedures to 

safeguard and account for cost-share payments.14 Six of the twelve 

States that cost share do not have procedures specifically for the 

accounting of cost-share payments. Officials from the area agencies in 

these six States report that they have not received any specific guidance 

from their State about accounting for cost-share payments. 

None of the States has created the required written materials on cost 

sharing 

Pursuant to the OAA, States that cost share must create written 

materials that explain the criteria for cost sharing, the sliding scale, 

and the fact that services cannot be denied to an older individual due to 

income or failure to make payment. States must require the area 

agencies and service providers to widely distribute the written 

materials.15 

None of the 12 States that cost share have created the written materials 

to explain cost sharing to recipients. State officials in all 12 States 

expect their area agencies or providers to inform recipients about cost 

sharing. The area agency officials whom we interviewed report that the 

area agencies or providers inform recipients about cost sharing during 

the intake process or prior to providing the service. However, only 1 of 

the 21 area agencies we interviewed had written materials that 

provided detailed information about cost sharing for recipients. 

AoA has provided limited guidance to States and 

State officials are often confused about features 

of cost sharing under the OAA 

AoA has not provided States with 

comprehensive guidance on cost 

sharing 

AoA has provided limited 

guidance to States on implementing cost sharing in accordance with the 

OAA. AoA conducted for its regional offices an initial training session 

that included training materials that were distributed to them to share 

14 42 U.S.C. § 3030c-2(a)(5)(B).

15 42 U.S.C. § 3030c-2(a)(5)(G).

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 13 
F I NDING S 

with States. However, the training did not cover key requirements, 

such as the plans States are required to develop and the written 

materials that explain cost sharing that States must create. AoA also 

posted a few frequently asked questions about cost sharing on its Web 

site; however, the information has since been removed.16 A table 

comparing the 1992 and 2000 amendments to the OAA is currently 

available on AoA’s Web site, but it is difficult to find. The information 

does not readily come up in searches and only appears at the end of 

several different menu prompts. Lastly, AoA officials report that they 

provide technical assistance to individual regional offices or States 

when questions arise. 

In addition, based on our interviews, we found that AoA officials have 

limited information about how States are implementing cost sharing. 

For instance, they have little knowledge about States’ plans regarding 

cost sharing, their sliding scales, accounting for cost-share payments, or 

informing recipients about cost sharing. 

Officials from some State and area agencies do not fully understand cost 

sharing 

Officials from several States and area agencies are confused about 

features of cost sharing for OAA services. Based on our written survey 

of all States and subsequent interviews with State and area agency 

officials and our review of relevant documentation, we found that 

officials from 13 of 52 States did not correctly understand the status of 

cost sharing in their State. Specifically, officials in eight States 

confused State-funded services with those funded by the OAA. Officials 

in three States confused voluntary contributions or their voucher and 

reimbursement programs with cost sharing. Additionally, officials in 

two States could not identify which area agencies in their States have 

implemented cost sharing. 

16 There are currently two questions about cost sharing posted on AoA’s Web site but they 

are very general. 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 14 
F I NDING S 

AoA’s participation data cannot be used to 

determine the impact of cost sharing on 

participation rates 

AoA is required to conduct 

an annual evaluation of 

cost sharing to determine 

its impact on participation 

rates, with particular attention to low-income and minority older 

individuals and older individuals residing in rural areas.17 AoA collects 

participation data for many OAA services through the NAPIS/SPR. As 

mentioned previously in this report, the NAPIS/SPR does not contain 

information specific to cost sharing but it does contain the total number 

of people participating in many of the services that are cost shared. 

AoA uses the NAPIS/SPR data to plan and manage activities performed 

and services provided under the OAA. 

We found that States report data in the NAPIS/SPR differently and that 

the demographic data in the NAPIS/SPR are incomplete. As a result, 

the data in the NAPIS/SPR do not present a complete picture of 

participation and, therefore, cannot be used to measure any impact that 

cost sharing might have on overall participation or on participation of 

low-income individuals and other subgroups specified in the OAA. 

States report participation data in the NAPIS/SPR differently 

Interviews with data officials in the 12 cost-sharing States show that 

States report participation data in the NAPIS/SPR differently. 

Specifically, data officials in seven States say that they include 

recipients of services funded solely by State or local entities in addition 

to recipients of OAA-funded services. In contrast, data officials in the 

other five States say that they do not include recipients of services 

funded solely by State or local entities when reporting to the 

NAPIS/SPR. 

The differences in reporting may be due to conflicting instructions that 

AoA provides to States. AoA officials report that they instruct States to 

count all recipients receiving services through the State Units, whether 

the services are OAA-funded or not. They note that reporting 

participation in this way is in line with the mission of the OAA to 

leverage these funds with other State and local money. At the same 

17 42 U.S.C. § 3030c-2(d). 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 15 
F I NDING S 

time, AoA’s Web site instructs States to count recipients of services that 

are funded in whole or in part by the OAA.

18 

Demographic data in the NAPIS/SPR are incomplete 

At the time we reviewed the data, we found that the demographic data 

in the NAPIS/SPR were incomplete. Although AoA has taken steps to 

resolve this issue, the NAPIS/SPR data do not currently provide a 

complete picture of participation for subgroups of the population. 

Therefore, the data cannot be used to measure whether cost sharing has 

had any impact on participation for the subgroups specified in the OAA, 

including low-income individuals. 

Specifically, we found that the original design specifications for the 

NAPIS/SPR required States to omit the demographic data for recipients 

missing any data element. Consequently, States had to delete all 

characteristics for a record that was missing an element such as race, 

ethnicity, disability status, or rural residence. AoA officials believe that 

this design specification resulted in significant undercounting of clients 

in the client-detail tabulations. These officials also report that they 

have no way of determining which characteristics were most affected by 

the design specification.19 Although AoA has changed the design 

specifications and the NAPIS/SPR now retains records with missing 

data elements, AoA officials stated that they “. . . do not believe that any 

of the quantitative program data now available can be employed to 

make inferences about the impact of cost sharing on program 

participation by vulnerable individuals.”20 

We also found that the data in the NAPIS/SPR do not include 

demographic information for all States. AoA was required to grant 

States waivers from submitting demographic data for Title III-B 

services. 21 AoA officials report that they have not received this 

information from more than 40 States in any fiscal year. As of 2005, 

however, AoA is no longer required to approve the waivers. 

18 U.S. Administration on Aging, Instructions For Completion of Title III and VII SPR. 

Available online at http://www.aoa.gov/prof/agingnet/napis/spr/spr_guidance/newn97.asp. 

Accessed August 10, 2006. 

19 Letter from AoA to Office of Evaluation and Inspections (January 24, 2005). 

20 Ibid. 

21 AoA was required to grant States waivers from submitting demographic data for 

recipients of Title III-B services by the initial Office of Management and Budget 

conditions of approval for the NAPIS/SPR data collection and the Paperwork Reduction 

Act of 1995. 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 16 
F I NDING S 

Further, the NAPIS/SPR does not include demographic data for Title 

III-E services. States have not been required to report demographic 

data for any Title III-E services, which include respite and 

supplemental services, two of the most commonly cost shared services. 

AoA officials report that States must now report certain demographic 

data for recipients of Title III-E services. 

States report that area agencies commonly have problems collecting 

accurate participation data 

State data officials in the nine cost-sharing States with area agencies 

report that area agencies commonly have problems collecting and 

reporting accurate participation data. The data officials note problems 

with limitations of their data systems, difficulties interpreting data 

definitions and requirements, and an inability to collect complete data. 

Data officials in these States report that they often have to estimate the 

number of persons served by the area agencies due to the problems their 

agencies experience collecting accurate data. AoA officials acknowledge 

that the NAPIS/SPR data are not consistently available for area 

agencies.22 

22 Letter from AoA to Office of Evaluation and Inspections (January 24, 2005). 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 17 
Δ RECOMME NDA TIONS 

States’ use of cost sharing for OAA-funded services is limited. Of the 

States that cost share, not all have followed OAA requirements for cost 

sharing that are designed to ensure that low-income individuals have 

access to services. To date, AoA has provided limited guidance to States 

about implementing cost sharing. Also, AoA’s participation data cannot 

be used to determine the impact of cost sharing on participation for lowincome individuals and other groups targeted by the OAA. Based on 

these findings, we recommend that AoA: 

Ensure that States’ cost-sharing practices comply with requirements 

designed to protect low-income individuals’ access to services. AoA 

should address State and area agency practices that permit low-income 

individuals to participate in cost sharing. AoA should also address 

State and area agency practices that deny services to older individuals 

due to income or failure to make a cost-share payment, as well as 

practices that make cost sharing appear mandatory. In addition, AoA 

should address the States’ lack of cost-sharing plans, sliding fee scales, 

policies for accounting for payments, and written material that explain 

cost sharing. 

Provide additional guidance to States about implementing cost 

sharing in accordance with the OAA. AoA should provide additional 

guidance to States regarding how to implement cost sharing in 

accordance with OAA requirements. The guidance should address 

issues such as (1) developing plans to ensure that the participation of 

low-income individuals will not decrease with the implementation of cost 

sharing; (2) excluding low-income individuals from cost sharing; 

(3) prohibiting the denial of services; (4) establishing sliding scales; 

(5) developing procedures to account for cost-sharing payments; and 

(6) preparing written materials to inform recipients about cost sharing. 

AoA should also develop additional strategies to keep States informed 

about these issues. 

Improve the quality of the NAPIS/SPR data so that any effects of 

cost sharing can be measured. AoA should improve the quality of its 

data to measure any future impacts cost sharing may have on 

participation rates, as required by the OAA. During the course of this 

study, AoA has addressed some of the data problems. Specifically, the 

NAPIS/SPR now retains records with missing data elements; the 

NAPIS/SPR now collects some demographic data for recipients of Title 

III-E services; and AoA is no longer required to approve waivers to 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 18 
R E C O MMENDA T I O N S 

States. However, AoA has not addressed the differences in State 

reporting. 

When addressing these differences, AoA needs to give clear and 

consistent instructions to States and consider whether to continue 

directing States to report information for all services, including those 

funded solely by State or local entities. If the NAPIS/SPR includes data 

about non-OAA-funded services, then AoA needs to consider how it will 

determine any effects of cost sharing on participation in OAA programs 

and services, as required by the OAA. 

In addition, the inconsistency of AoA’s participation data has 

implications beyond cost sharing. This study focuses only on cost 

sharing, but the differences in data reporting raise questions about how 

AoA can use the data to effectively plan and manage activities funded 

under the OAA. This broader issue affects AoA’s capacity to manage all 

aspects of these services, not only cost sharing. 

AGENCY COMMENTS 

AoA provided comments on the draft report. In general, AoA agrees 

with our findings that cost sharing is limited and that States are 

confused about cost sharing. AoA states that it has taken many steps to 

educate the Aging Network on cost sharing and does not agree with our 

finding that it has provided limited guidance to States. AoA also states 

that our observations about NAPIS/SPR are outside the scope of the 

study and that it has made several improvements to NAPIS/SPR over 

the last 5 years. In response to our recommendations, AoA notes that it 

will follow up on our observations and correct instances of 

noncompliance with the provisions of the OAA. AoA also plans to 

provide additional guidance to States on an ongoing basis and post more 

information on its Web site. The full text of the comments is included in 

Appendix A. 

OFFICE OF INSPECTOR GENERAL RESPONSE 

Where appropriate, we have made changes to the report based on AoA’s 

comments. 

Because the OAA requires AoA to determine the impact of cost sharing 

on participation rates, and NAPIS/SPR is the only data AoA has on 

participation, we believe that it is necessary to include NAPIS/SPR in 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 19 
R E C O MMENDA T I O N S 

any discussion about whether cost sharing has had an impact on 

participation rates. 

We recognize that AoA has made several improvements to NAPIS/SPR 

over the last 5 years, many of which are noted in the report. However, 

despite these improvements, we found that the States that cost share 

report participation data in the NAPIS/SPR differently and include 

different populations in their counts. This issue is important because it 

has potential implications beyond cost sharing. These data provide 

essential information for AoA, including performance outcome 

information required by the Government Performance and Results Act 

and the Performance Assessment Rating Tool. 

 OE I-02-04-00 290 C O S T S HARI N G F O R OLDER A MERI C A NS ACT S ERV I C E S 20 
APPEND X

Agency Comments

r-""~

( /t ~'-

DEPARTMENTOFHEALm &.HUMA SERVICES Ofce of the Assistnt Secrtary

Admfn.!.tration on Aging

Washington D.C. 20201

JUN ! 2 2005 0-.,

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,

'J n (":? 'i 0";

fTC; l'.' :)

fT- cr :

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TO: Daniel R. Levinson

Inspector Gener /. 1' Î /'~, A~. .

EdwiL. Wa1er~

Deputy Assistat Seceta for Policy and Progrms

FROM:

SUBJECl: Adminstron onAgig Comments in Response to

OIG Draft Report: "Cost Shang for Older Amerca Act Serice,"

OEI-02-04-00290

Summary of Comments

The Administrtion on Agig (AoA) recgnze the crtical importce of assessin

progr imlemenon, and more importtIy, progr perormce caed out under

the Older Amerca Act In regntion of the requiements of the Older Amerca Act

(OM), and the evdent cistace th imlementation of cost shg under the OAA

wa ver limite AoA requested th Offce of Inpector General (OIG) to undere an

!'aluaton of cost sharng for OM serce.

In commentig on the findings of the OIG related to cost shng under the OM, AoA wants to acknowledge the diffculty 9fthe tak we reuesed the OIG to perform. AoA

knew that implementation of cost sharg under the OM was ver limited, and felt tht it

would remain so even though cost sharng for related statefuded progrs was

common. We believe tht the OIG work confied that implementaton of cost shag

under the OM is and wi reai ver liited Ver few staes have implemented it for

OAA fuded progr, and for those who have implemented it at all, the level of

implementation was usualIy ver limted both in tenu of coverge across the state an of

servce included It should be D9ted that the OM does not reuie sttes to implement

cost shg, so this outcome does not violate the intent of the OM in any way. We had hope to lear more about the barers that have caused sttes to choose not to tae

advatage"ofths new provision. However, that type of anlysis did not oc. As a

result, the review did Dot provide the tye of information that would sere AoA and the

aging network to help to modifY program requirements of the Act in a way th would allow the OM to be mode, and allow the network to tae" advantage of the positive

aspects of cost shag, whie protecting the nees of elderly individuals at greaest social

and economic risk.

AoA appreciates the obsertions of the OIO related to conce about compliance by the

States with the cost shang provions of the OM. However, we do not believe that the

OEI.02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 21
APPEND X

Page 2 - Daniel R. Levison

stdy was adequate to ma generalizatons about the impa of state and local actions

across OM programs. Dat provided by the OIG on the numbe of individus

parcipat in cost sharg clealy indicae that implementaton ha not bee exteive

enough to have had a signficat effec on any broad OAA client population grup. The

OIG da indicate th cost sh under the OM Isnot ocng to any signficat

degree for any progr activity. AoA wil follow up on the obseratous of the OIG to

corr,ect ince of non-compliance with the provisions of the OM where they may

exst. We also believe that if fuer implementation of cost sharng occ, .it will requie ongoin confirmation of compliance with the provisions of the OM.

We apprete th the stdy was able to correct may ofits ealier obseratons

assoiated with the Natonal Agig Progr Inormaton System (NAlIS). We believe

th the diffcuties the study encounter reflec litaons with the methodlogy and

the limts of implementtion of cost shg, an not problem with the NAPIS system.

The NAPIS da system is, in fact, well maged and cordinated AoA works ver

closely with representaves of ste and ar agenes on agig to ensre th th data

colIected under the NAPIS system is focused on chctèrcs an data th supprt crtica and necesa program management acvity. In the pas five yea, AoA the

state, area agencies, nationa assoiatons of stat an ar agencies, and highly

expeence OAA progr data vendors have put signficat effort into the improvement

of OM prgr dat and ths signfica and ext~ve collabraon will Continue.

State implementadon of rost-sharig

Based on AoA's experence in workig with the sttes to imlement cost sharng and

other provisions under the Act we believe that many of the conclnsonsofthe stuy

about Sta exection of the cost-sharg provisions do not adequately reflect th(:

complexity of the issue under the Older Amercas Act nor do th give a complete

pictue of how the states ar implementing Cost-shag.

Firt, a required element under the OM of Sta an Area plan is.th they enure the

parcipation of low-income individuals thughout thei repetive plan in ALL OAA

serce, includg those tht are cost shared (see State plan atchmentsA&B). AoA

does not believe it is nees or effecve for States at tl tie to set up a Separte plan

relat to cost-sharg, becuse ther is litte evdence of plans to mae it extensive, and

becuse broader prograr dat indicate signficat protecons of client populations. The

data below indicate tht States and AAs are effecvely addsing the tagetig of

serce to individuals with low-incomes thughout thei resve State and Ar plan

10% of U.S. elders are poor; 28% ofOAA cllents are poor.

16% ôf elders are miority; 22% of clients are miority.

24% of U.S. elders reside in rural area; over 21% of OAA cUents are rural.

Second, under the Older Amercan Act, States, AA and providers are reuired to

allow older individuals to contrbute to the cost of thei servce. This requireent often

creates diffcuties for State attptin to implement cost sharg. On the one hand, the

cost shag provision doe not allow for charg fee to low-inc'me tndividus, while

OEI.02-04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 22
APPEND X

Page 3 - Danel R. Levinson

other provisions requi title II provider to give all parcipats the oppty to

voluntaly contrbute to the cost of their serice. Melding these provisions togeter

under a syste where parcipats self declar thei incomes ca get trck and takes

extr plang. Ths is an isue that AoA is trng to addres fuer in follow-up

gudace to Regional AoA offce and State agencies on agig. AoA plas to expand

previous "frequently asked questions" related to cost-shag, post the inormation on its

website, and prvide additiona guidace to the States on an ongoing basis for Staes that

are cost sharg.

Th may States have cost shag provions under thei own stae-funded progrs .

or frm other source. When dicussing cost sharng actvities with States, it is AoA's

expeence tht States someties confu the cost shg protocols of other fuding

soures with those of OM progt, parcularly give the fidig that in 6 of the 12

stats which implement cost sharg under the OAA fewer th 350 inviduas

partcipate. These data indicate th the larger. issue may not be confion by State when

implementing cost sharng, but rather tht co shag uner the OM barly exist 

at all.

Fourt many States have indica tht they wan to be able to us cost shang to expand

dwidling reures for a grwig population of seniors, an tht they want to be able to merge OM progt with their own succfu State fuded cost shang progr. If

States are incorrectly implementi CO.st sharg under the OAA one of the n: resous

may be becus ,co sha proviions under the OM do not genery meld well with

their own cost sharg program.

AoA guidance to the States on cost-sharig.

Whle we appreciate the OIG's recommendations for how AoA ca improve the level of

trni on cost sharng under the OM, we do not support the reprt's conclusion that

little guidace has bee provided. Since the enactment of cost shag under the OAA AoA has taen seeral stregies and actons to educate the agig serce netork on

this prvision, including the followig actvities:

· 'AoA developed a PowerPoint preention, and conducted a videonfernce

dug thefut six months following the enactent of the provision. (4/2001)

· Regional Offces used the PowerPoint preention with the Staes in their region

durng plaied trning sessions, and made copies of the preenation avaiable to

State Agencies.

· AoA conducted a conference cal with Regiona AoA offces dedcated to the

discussion of cost sharng; cost shang question were fielded by AoA durng

other conference cals, as neeed. (216/02)

· AoA followed up the conference call with an email to Regional offce givig

fuer direcon on cost shar and providing a copy of the statutory language.

(217/02)

· AoA developed "frequently asked questions" (FAQs) on aU of the chages in the 2000 amendments, including cost sharg, and made those F AQs available on the

website for over two year. As mentioned above, AoA plan to expand the FÀQs

and post again on the website.

OEI-02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 23
APPEND X

Page 4 -' Danel R. Levinson

· AoA worked with the Regional Offce to conduct a surey of States relatd to thei cost sharg actities. (9/200)

· Regional Offce have contiued to provide technica assistace on cost sha

(along with comprehenive TA on the ente OM) durng orientation training

with new Stae agency staff and durg provider, AM and State agency traing

conferecemee, as approprate.

· AoA contiues to wor with Regional Offces to resnd to cost shag inquires,

as needed. (1112000 to preent) Docuenon of cae-by-casegudace is

majntaed at Regional Offces of AoA in trp report and email corrpondence.

Quality ortheNAPISISPR Data

The spec intent of the study requested was to beter underitad Cost shag unde the

OM, and not to provide anecota obseatons abut the overll data and informaton

available frm NAPIS/SPR. On ths latter point, the rert went well beyond the intent of

the sty an the consnts of its own metodologica design and led to obseratons

that faed to incorprate significat relevant data AoA expres the followig serious

conce abut the validity of the study methodology and conclusions regardig

NAPIS/SPR, although we do recgne ,that the report now acknowledgeS the cotion

of some of those obseations.

· Ther is no valid basis for making generons about an enterrise-wide,

national information system in a study tht addesses the lite implementaon

of cost sharg. Given the timig of the legislative prvision, the fa that

implementaon was discetona, and the clea effec that implementaon Was

severely limted there should have bee no expecttion that rertng on cost

shag would be incorporated into NAPIS.

· In the 12 sttes where some level of cost shag was implemented the number of

perons parcipating in cost sharg (a tota numbe of pacipants is not

provided but individua sttes reortedly rage frm 55 peons to i ,878 persons)

is a ver small fraction of the tota number of perons seed under the OM in

these same stes (over 1.4 milion peons).

· Approxily 50% of these states have implemented cost shag in only limited

ars of the state and none has implemented cost sharg for all of the allowable Title II serce.

· The NAPIS/SPR has never bee nor will it be, designed as a client tracking

system. It is desgned to provide broad agggated progr and management

inormaton to AoA, consistent with what ha been deeed accptale and

adequate, and approved by the Offce of Maagement and Budget (OMB) for

AoA. SUAs, AAs and providers fruently collect and maita addtional

client level information for loc management purses, but this data is not to be

conf with the aggrgated NAPIS/SPR format aIlowed for AoA by OMB.

Whle the report offere a broad recmmendaton for AoA to ".. .improve the quaty of

its da.. .," it faled to identifY the ver specific and extenive data imprvement effort

that have character the NAPIS system over the last five yea. AoA, the National

Association of State Units on Aging, a major nationaÍ NAPIS data vendor, other

OEI.02.04-00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 24
APPEND X

Page 5 - Daniel R. Levison

experence dat constats, and numerous individua state and area agencies have bee

actively enged in the modemíaton and iiprovement of 

the NAP IS da syst over

the last five yea, and th effort contiues. In the recet, signficat, and OM:-

approved revision of the NAPIS data reuirements (and reprtg system) that have

taken effec for the FY 2005 reportng perod, AoA and its data improvement parers sought formal input frm the entie aging netork of state and ar agcies no fewer

than four ties. AoA and its da improvement coalition have continued to pur the

long-te modertion of data programs through the NAPIS Dat Magement Study,

. which aga has puued inut and paricipation in a varet of meda from agig netork entities.

The stuy faled to identify these effort and intiatives becus thes efforts are

signficatly beyond the scope of the sty the OIG was eiigagedto pero:i. AoA ha

formaly occpied signficat professional entities that are qualified to gude the Agency

and the Netork in puring improvements to these importt daa operations, and AoA

wilI look to these entities for recmmendatons related to the imprvement of the NAPIS

system. To effectively manage and rert on program actvities, AoAhas grtly

enced acc to tiely, ace, and integrte data an inormation. AoA has taen

several importt steps to ensue the avaiabîlty of ths essential inormation: (I)

development of the Nationa Agig Program Inormtion Syste and the State Progr

Reprt (1995) as revised and imlemen for FY 2005 reprtng, (2) proviion of

softar support and tr (State Reportg Tool - SR1) to falitate state submiion

of the SPR to en tiely and accate SPR inormaton, and (3) extensive procedural

gudance on the use of thes tools and contiuay updag responses to Frequently

Asked Questions (F AQ) frm the Agig Netor NOTE: The insctons discussed in

the last paragrph on page 15 and footnote #18, reference the previous verion of

NAPIS/SPR. The FY 2005 NAPIS/SPR

(http;llww.aoa.irv/Drof/airgletAPIS/docsSPR_Modified_Fonn_1 i .08.04'Pd~ and F AQs

(htt:llww.a6uov!urotìaiiiretIAPIS/SPRlSPR irdaceIAPIS-FAOs03032006.d ) ar the

. most recnt and correc versions of these documents These developments cleary

provide detaled rertirg inrmaton and insctions regag the inclusion of servces

fuded thugh the OM, stte genera! revenue and other source.

The SPR provides essential informon on the charactenstics of clients including:

demograplùc and diility dat; the tyes and levels of serce, such as the number of

persns serce and the unts of servce provided by the network on aging; expenditues

of OM fuds and from other sourcs; and adstrive information about SU As and

AAs, including staff levels and rensibilties, as welI as the number of volunteer providing support The 010 reor (page 16) states tht "...dat in the NAPIS/SPR do

not include (client) demographic data information for al states." Whe some sta have

not prviously reported client demogrphic data i i of the 12 states tht have

implemented cost sharng have submitt some level of client deogrhic inormation.

As required under former OAA stattory authority, the 12th state recived a waiver of

demographic reportng responsibilty. Such waiver were reqired by OMB conditions of

approval for the former verson of the NAPrS system.

OEI.02-04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 25
APPEND X

Page 6 - Daniel R. Levinson

The SPR dat provdes essetial infonntiOii for AoA. These data have provided

signficat peormance outcome inormon requied by the GovenentPerformance

and Rests Act (GPRA) an the Perormce Assssient Rati Tool (PART). AoA's

abilty to recently receve a P ART score of8 i, and OMB lùgbghng of the quaity of

AoA perormance mea in the FY 2005 Preident's Budget is bas to a consderable

degee on obtaing nec managent inormation from NAPISISPR.

As pa of contnuous quality imovement and to fuer refie the data reprtg

procees in the Agig Network AoA enter into a coopetve agrent with the

National Associaton of State Units on Agig (NASUA) to identify ways for AoA, SUAs,

and MA to imprve the effciency and effecven of 

rertg and to reuc the

burden of informaton colIecon. The stdy is focus on cost-effecve ways to:

i. Defie the common data requents necsa for policy and management

decision makg, includg stte and loca initiatives (includig advoccy) so as to limit

feder requien to a sub-set of ste and local reuients .

2. Elinat the need for elderly individuals and cagiver to provide identifyng

inormation repedy to varous serce prviders

3. Improve data colIection methods and syss so as to insure obtanig

unduplica coun ofíndividuas acrss serce prvide and gegrhic locatons

4. Reduce the expee of report sysem fragmentation by tag advatage of

network ecomies of scae for informaton sytem development and management without compromiin competition in the maretlac

Whle stilI in the dr stages, the report wil assis AoA in fuerng the integty of data

and informaton supplied by the Agig Netork.

OEI-02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 26
APPEND X

ATTACHMENT A

Listing of State Plan Assurances and Required Activities

Older Americans Act, As Amended in 2000

By signing this document, the autorized Dffcial commits the State Agency on Aging to

performing all listed assurances and required activities.

This attachment, along with requirements listed in the State Plan Guidance Program

Instruction (PI) and attachment 8 State Plan Provisions and Information Requirements,

make up the package of instrctions for development of State Plans.

ASSURANCES

Sec. 305(a)- (c), ORGANIZATION

(a)(2)(A) The State agency shall, except as provided in subsection (b)(5), designate

for each such area (planning and servce area) after consideration ofthe views offered

by the unit or units of general purpose local government in such area, a public or

private nonprofit agency or organization as the area agency on aging for such area.

(a)(2)(8) The State agency shall provide assurances, satisfactory to the Assistant

Secretary, that the State agency wil take into account, in connection with matters of

general policy arising in the development and administration of the State plan for any

fiscal year, the views of recipients of supportive sGrvces or nutrition services, or

individuals using multipurpose senior centers provided under such plan.

(a)(2)(E) The State agency shall provide assurance that preference wil be given to

providing services to older individuais with greatest economic need and older

individuals with greatest social need, with particular attention to low-income minority

individuals and older individuals residing in rural areas and include proposed methods

of carring out the preference In the State plan.

(a)(2)(F) The State agency shall provide assurances that the State agency wil

require use of outreach efforts described in section 307(a)(16)..

(a)(2)(G)(ii) The State agency shall provide an assurance that the State agency wil

undertake specific program development, advocacy, and outreach efforts focused on

the needs of low-income minority older individuals and older individuals residing ;n

rural areas.

(c)(5) In the case of a State specified in subsection (b)(5), the State agency and area

agencies shall provide assurance, determined adequate by the State agency, that the

area agency on aging wil have the ability to develop an area plan and to carr out,

OEI.02-04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 27
APPENDIX

directly or through contractual or other arrangements, a program in accordance with

the plan within the planning and service area.

States must assure that the following assurances (Section 306) wil be met by its

designated area agencies on aaencies. or bv the State in the case of sln(:le

planning and service area states.

Sec. 306(a), AREA PLANS

(2) Each area agency on aging shall provide assurances that an adequate proporton,

as requited under section 307(a)(2), of the amount allotted for part B to the planning

and service area will be expended for the delivery of each of the following categones of

services-

(A) services associated with access to services (transportation, outreach,

information and assistance, and case management services);

(B) in-home services, including supportive services for familes of older individuals

who are victims of Alzheimer's disease and related disorders with neurological and

organic brain dysfunction; and

(C) legal assistance;

and assurances that the area agency on aging wil report annually to the

State agency in detail the amount of funds expended for each such category

during the fiscal year most recently concluded.

(4)(A)(i) Each area agency on agil1g shall proVide assurances that the area agency on

aging wil set speCific objectives for providing services to older individuals with greatest

economic need and older individuals with greatest social need, include specific

objectives for providing services to low-income minority individuals and older

individuals residing in rural areas, and include proposed methods of carrng out the

preference in the area plan.

(4)(A)(ii) Each area agency on aging shall provide assurances that the area agency

on aging wil include in each agreement made with a provider of any servIce under

this title, a requirement that such provider will-

(I) specify how the provider intends to satisfy the service needs of low-income minority

individuals and older individuals residing in rural areas in the area served by the

provider;

(II) to the maximum extent feasible, provide services to low-income minorit

individuals and older individuals residing in rural areas in accordance with their need

for such services; and

(ill) meet specific objectives established by the area agency on aging, for providing

. services to low-income minority individuals and older individuals residing in rural

areas within the planning and service area.

(4 )(A)(ii) With respect to the fiscal year preceding the fiscal year for which such

plan Is prepared, each area agency on aging shall2

OEI.02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 28
APPEND X

(I) identify the number of low-income minority older individuals and older individuals

residing in rural areas in the planning and service area;

(II) describe the methods used to satisfy the servce needs of such minority older

individuals; and

(III) provide information on the extent to which the area agency on aging met the

objectives described in clause (a)(4)(AXi).

(4)(BXil Each area agency on aging shall provide assurances that the area agency

on aging wil use outreach efforts that wil identif individuals eligible for assistance

under this Act, with special emphasis on-

(I) older individuals residing in rural areas;

(II) older individuals with greatest economic need (with partcular attention to

low-income minority individuals and older individuals residing in rural areas);

(III) older individuals with greatest social need (with particular attention to low-income

minority individuals and older individuals residing in rural areas);

(IV) older Individuals wit severe diSabilties;

(V) older individuals with limited English-speaking abilty; and

(Vi) older individuals with Alzheimets disease or related disorders with neurologicai and

orgánic brain dysfunction (and the caretakers of such individuals);

and inform the older individuals referrd to in (A) through (F), and the caretakers of such

individuals, of the availabilty of such assistance.

(4)(C) Each area agency on agency shall provide assurance that the area agency on

aging will ensure that each activity undertaken by the agency, including planning,

advocacy, and systems development, wil include a focus on the needs of low-income

minority older individuals and older individuals residing in rural areas.

(5) Each area agency on aging shall provide -assurances that the area agency on

aging wil coordinate planning, identification, assessment of needs, and provision of

servcès for older individuals with disabilities, with partcular attention to individuals

with severe disabilties, with agencies that develop or provide services for individuals with disabilties. .

(9) Each area agency on aging shall provide assurances that the area agency on

aging, in canying out the State Long-Term Care Ombudsman program under section

307(a)(9), wil expend not less than the total amount of funds appropriated under this

Act and expended by the agency in fiscal year 2000 in canying out such a program

under this title.

(11) Each area agency on aging shall provide information and assurances concerning

servces to older individuals who are Native Amencans (referred to in this paragraph

as "older Native Americans"), including-

(A) information concerning whether there Is a Significant population of older Native

Americans in the planning and service area and If so, an assurance that the area

agency on aging wil pursue activities, including outreach, to increase access of those

older Native Americans to programs and benefits provided under this tile;

3

OEI-02-04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 29
APPEND X

(B) an assurance that the area agency on aging wil, to the maximum extent

practicable, coordinate the services the agency provides under this title with services

provided under title VI; and

(C) an assurance that the area agency on aging will make servces under the area

plan available, to the same extent as such services are available to older individuals

within the planning and service area, to older Native Americans.

(13)(A) Each area agency on aging shall provide assurances that the area agency on

aging wil maintain the integrity and public purpose öf services provided, and service

providers, under this title in all contractual and commercial relationships.

(13)(8) Each area agency on aging shall provide assurances that the area agency

on aging wil disclose to the Assistant Secetary and the State agency-

(i) the identity of each nongovemmental entit with which such agency has a contract

or commercial relationship relating to providing any service to older individuals; and

(ii) the nature of such contract or such relationship.

(13)(C) Each area agency on aging shall provide assurances that the area agency will

demonstrate that a loss or diminution in the quantity or quality of the services

provided, or to be provided, under this title by such agency has not resulted and wil

not result from such non-govemmental contracts or such commercial relationships.

(13)(0) Each area agency on aging shall provide assurances that the area agency

wil demonstrate that the quantity ör quality of the services to be provided under this

title by such agency wil be enhanced as a result of such non-governmental contracts

or commercial relationships.

(13)(E) Each area agency on aging shall provide assurances that the area agency

wil, on the request of the Assistant Secretary or the State, for the purpose of

monitoring compliance with this Act (including conducting an audit), disclose all

sources and expenditures of funds such agency receives or expends to provide

servces to older individuals.

(14) Each area agency on aging shall provide assurances thatfunds received under

this title wil not be used to pay any part of a cost (including an administrative cost)

incurred by the area agency on aging to carr out a contract ör commercial

relationship that is not carried out to implement this title. .

(15) Each area agency on aging shall provide assurances that preference in receiving

services under this title wil not be given by the area agency on aging to particular

older individuals as a result of a contract or commercial relationship that is not carried

out to implement this title.

Sec. 307, STATE PLANS

4

OEI.02.04,00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 30
APPEND X

(7)(A) The plan shall provide satisfactory assurance that such fiscal control and

fund accounting proceures will be adopted as may be necessary to assure

proper disbursement of, and accunting for, Federal funds paid under this tille to

the State, including any such funds paid to the recipients of a grant or contract.

(7)(8) The plan shall provide assurances that-

(i) no individual (appointed or otherwse) involved in the designation of the State agency

or an .area agency on aging, .or In the designation of the head of any subdivision of the

State agency or of an area agency on aging, is subject to a conflct of interest

prohibited under this Act;

(ii) no officer, employee, or other representative of the State agency or an area

agency on aging is Subject to a conflict of interest prohibited under this Act; and

(iii) mechanisms are in place to Identify and remove conflcts of interest prohibited

under this Act.

(9) The plan shall provide assurances that the State agency wil carr out, through

the Offce of the State Long-Term Care Ombudsman, a State Long-Term Care

Ombudsman program in accordance with section 712 and this title, and wil expend

for such purpose an amount that is not less than an amount expended by the State

agency with .funds received under this tite for fiscal year 2000, and an amount that is

not less than the amount expended by the State agency with funds received under

tille VII for fiscal year 2000.

(10) The plan shall provide assurance that the special needs of older individuals

residing in rural areas wil betaken into consideration and shall describe how those

needs have been met and describe how funds have been allocated to meet those

needs.

(11 )(A) The plan shall provide assurances that area agencies on aging wil--

(i) enter into contracts with providers of legal assistance which can demonstrate the

experience or capacit to deliver .legal assistance;

(ij) include În any such contract provisions to assure that any recipient of funds under

division (A) will be subject to specifc restrictions and regulations promulgated under

the Legal Services Corporation Act (other than restrictions and regulations governing

eligibilty for legal assistance under such Act and governing membership of local

governing boards) as determined appropriate by the Assistant Secretary; and

(ii) attempt to Involve the private bar in legal assistance activities authorized under this

tille, including groups within the private bar furnishing services to older individuals on a

pro bono and reduced fee basis.

(11 )(8) The plan contains assurances that no legal assistance wil be furnished

unless the grantee administers a program designed to provide legal assistance to

older individuals with social or economic need and has agreed, if the grantee is not a

Legal Services Corporation project grantee, to Cbordinate its services with existing

Legal Services Corporation projects In the planning and service area in order to

concentrate the use of funds provIded under this title on individuals with the greatest

5

OEI-02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 31
APPENDIX

such need; and the area agency on aging makes a finding, after assessment,

pursuant to standards for service promulgated by the Assistant Secretary, that any

grantee selected is the entity best able to provide the particular services.

(11 )(D) The plan contains assurances, to the extent practicable, that legal assistance

furnished under the plan wil be in addition to any legal assistance for older individuals

being furnished with funds from sources other than this Act and that reasonable effort

will be made to maintain existing levels of legal assistance for older Individuals;

(11 )(E) The plan contains assurances that arèa agencies on aging wìlgive priori

to legal assistance related to income; health Care, long-term care, nutrition,

housing, utilites, protective services, defense of guardianship, abuse, neglect, and

age discrimination.

(12) The plan shall provide, whenever the State desires to provide for a fiscal year for

services for the prevention of abuse of older individuals, the plan contains assurances

that any area agency on aging carring out such services wil conduct a program

consistent with relevant State law and coordinated with existing State adult protective

service activities for-

(A) public education to identify and prevent abuse of Dlder individuals;

(8) receipt of reports of abuse of older individuals;

(e) active participation of older individuals participating in programs under this Act

through outreach, conferences, and referral of such individuals to other social service

agencies or sourcs of assistance where appropriate and consented to by the parties to

be referred; and

(D) referral of complaints to law enforcement or public protective service agencies

where appropriate.

(13) The plan shall provide assurances that each State will assign personnel (one of

whom shall be known as a legal assistance developer) to provide State leadership In

developing legal assistance programs for older individuals throughout the State.

(14) The plan shall provide assurances that, if a substantial number of the older

individuals residing in any planning and service area in the State are of limited

English-speaking abilty. then the State wil require the area agency on aging for

each such planning and service area-

(A) to utilze in the delivery of outreach services under section 306(aX2XA), the

services of workers who are fluent in the language spoken by a predominant number

of such older individuals who aré of limited English-speaking abilty and

(8) to designate an individual employed by the area agency on aging, or available to

such area agency on aging on a full-time basis, whose responsibilties will include--

(i) taking such action as may be appropriate to assure that counseling assistance is

made available to such older indíviduals who are of limited English-speaking abilty in

order to assist such older individuals In participating in programs and receiving

assistance under this Act; and

6

OEI-02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 32
APPEND X

(ii) providing gUidance to individuals engaged in the delivery of supportive services

under the area plan involved to enable such individuals to be aware of cultural

sensitivities and to take into account effectively linguistic and cultural oifferences.

(16) The plan shall provide assurances that the State agency wil require outreach

efforts that will identify individuals eligible for assistance under this Act, with special

emphasis on--

(A) older individuals residing in rural areas;

(8) older individuals with greatest economic need (with particular attention to

low-income minority individuals and older individuals residing in rural areas);

(C) older individuals with greatest social need (with particularalterition to low-income

minority individuals and older individuals residing in rural areas);

(D) older individuals with severe disabilties;

(E) older individuals with limited English-speaking abilty; and

(F) older individuals with Alzheimets disease or related disorders with neurological and

organic brain dysfunction (and the caretakers of such individuals);and inform the older

individuals referred to in clauses (A) through (F) and the caretakers of such individuals,

of the availability of such assistance.

(17) The plan shall prOVide, with. respect to the needs of older individuals with severe

disabilties, assurances that the State will coordinate planning, identification.

. assessment of needs, and service for older individuals with disabilties with particular

attention to individuals with severe disabilties with the State agencies withprimary

responsibilty for individuals with disabilties, including severe disabilites. to enhance

services and develop collaborative programs, where appropriate, to meet the needs of

older individuals with disabilties.

(18) The plan shall provide assurances that area agencies on aging wil conduct efforts

to faciltate the coordination of community-based, long-term care services, pursuant to section 306(a)(7), for older individuals who- .

(A) reside at home and are at risk of institutonalization because of limitations on their

abilty to function independently;

(8) are patients in hospitals and are at risk of prolonged instiutionalization; or

(C) are patients in long-term care facilties, but who can return to their homes if

community-based services are provided to them.

(19) The plan shall include the assurances and description required by section

705(a).

(20) The plan shall provide assurances that special efforts wil be made to

provide technical assistance to mInority providers of services.

(21) The plan shall

(A) provide an assurance that the State agency wil coordinate programs under this

title and programs under title VI, if applicable; and

7

OEI-02.04.00290 COST SHARING FOR OlOER AMERICANS ACT SERVICES 33
APPENDIX

(8) provide an assurance that the State agency wil pursue activities to increase

access by older individuals who are Native Americans to all aging programs and

benefits Provided by the .agency, including programs and benefits proVided under this

title, if applicable, and specify the ways in which the State agency intends to

implement the activities.

(22) If case managemÈmt services are offered to provide acceSs to supportive

services, the plan shall provide that the State agency shall ensure compliance wit

the requirements specified In section 306(a)(8).

(23) The plan shall provide assurances that demonstrable efforts wil be made-

(A) to coordinate servces provided under this Act wih other State services that benefit

older individuals; and

(8) to provide multigenerational activities, such as opportunities fòr older individuals to

. serve as mentors or advisers in child care, youth day care, educational assistance,

àt-risk youth intervention, juvenile delinquency treatment, and family support programs.

(24) The. plan shall proVide assurances that the State wil coordinate public

services within the State to assist older individuals to obtain transportation services

associated with access to servces provided under this title, to services under title

Vi, to comprehensive counseling services, and to legal assistance.

(25) The plan shall include assurances thatthe State has in effect a mechanism to

provide for quality in the provision of in-home services under this tille. .

(26) The plan shall proVide assurances that funds received under this title wil not be

used to pay any part of a cost (including an administrative cost) incurred by the State

agency or an area agency on aging to carry out a contract or commercial relationship

that is not camed out to implement this title.

Sec. 308, PLANNING, COORDINATION, EVALUATION, AND

ADMINISTRATION OF STATE PLANS

(b)(3)(E) No application by a State under subparagraph (b)(3)(A) shall be approved'

Unless it contains assurances that no amounts received by the State under this

paragraph will be used to hire any individual to fill a job opening created by the action

of the State in laying off or terminating the employment of any regular employee not

supported under this Act in anticipation of fillng the vacancy so created by hifing an

employee to be supported through use of amounts received under this paragraph.

Sec. 705, ADDITIONAL STATE PLAN REQUIREMENTS (as numbered in

statute)

OEI.02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 34
APPEND X

(1) The State plan shall provide an assurance that the State, in carring out any

chapter of this subtitle for which the State receives funding under this subtitle, wil

establish programs in accordance with the requirements of the chapter and this

chapter.

(2) The State plan shall provide an assurance that the State wil hold public hearings,

and use other means, to obtain the views of older individuals, area agencies on aging,

recipients of grants under title VI, and other interested persons and entities regarding

programs carred out under this subtitle. .

(3) The State plan shall provide an assurance that the State, in consultation with area

agencies on aging, wil identify and prioritize statewide activities aimed at ensuring that

older individuals have access to, and assistance in securing and maintaining, benefis

and rights.

(4) The State plan shall provide an assurance that the State will use funds made

available under this subtitle for a chapter in addition to, and wil not supplant, any funds

that are expended under any Federal or State law in existence on the day before the

date of the enactment of this subtitle, to carr out each of the vulnerable elder rights

protection activities described in the chapter.

(5) The State plan shall provide an assurance that the State will place no restrictions,

other than the requirements referred to in clauses (i) through (iv) of section

. 712(a)(5)(C), on the eligibilty of entities for designation as local Ombudsman entities

under section 712(a)(5).

(6) The State plan shall provide an assurance that, with respect to programs for

the prevention of elder abuse, neglect, 'and exploitation under chapter 3-

(A) in carring out such programs the State agency wil conduct a program of

services consistent with relevant State law and coordinated with existing State

adult protective service activities for-

(i) public education to identify and prevent elder abuse;

(ii) receipt of reports of elder abuse;

(iii) active participation of older individuals participating in programs under this Act

through outreach, conferences, and referral of such individuals to other social

service agencies or sources of assistance if appropriate and if the individuals to be

referred consent; and

(iv) referral of complaints to law enforcement or public protective service agencies if

appropriate;

(B) the State wil not permit involuntary or coerced participation in the program of

services described in subparagraph (A) by alleged victims, abusers, or their

households; and

(e) allinfomiation gathered in the course of receiving reports and making referrals

shall remain confidential except': .

(i) if all parties to such complaint consent in writing to the rele;:se of such infomiation;

9

OEI-02.04.00290 COST SHARING fOR OLDER AMERICANS ACT SERVICES 35
APPENDIX

(ii) if the release of such information is to a law enforcement agency, public

protective service agency, licensing or certification agency, ombudsman progràm, or .

protection or advocacy system; or

(ii) upon court order.

REQUIRED ACTIVITIES

Sec. 307(a), STATE PLANS

(1 )(A)The State Agency requires each area agency on aging designated under section

305(a)(2)(A) to develop and submit to the State agency for approval, in accordance with

a uniform format developed by the State agency, an area plan meeting the

requirements of section 306; and

(8) The State plan is based on such area plans.

Note: THIS SUBSECTION OF STATUTE DOES NOT REQUIRE THA T AREA PLANS

BE DEVELOPED PRIOR TO STA TEPLANS AND/OR THA T STA TE PLANS

DEVELOP AS A COMPILA nON OF AREA PLANS.

(2) The State agency:

(A) evaluates, using uniform procedures described in section'202(a)(29), the need for

supportive servces (including legal assistance pursuantto 307(a)(11), information and

assistance, and transportation services), nutrition services, and multipurpose senior

centers within the State;

(8) has developed a standardized process to determine the extent to which public or

private programs and resources (including volunteers and programs and services of

voluntary organizations) have the capacity and actually meet such need;

(4) The State agency conducts periodic evaluations of, and public hearings on,

activities and projects carred out in the State under titles II and VII, including

evaluations of the effectiveness of services provided to individuals with greatest

economic need, greatest social need, Or disabilties, with particular attention to lowincome minority individuals and older indMduals residing in rural areas. Note:

"Periodic" (defined in 45CFR Part 1321.3) means, at a minimum, once each fiscal year.

(5) The State agency:

(A) affords an opportunity for a public hearing upon request, in accordance with

published procedures, to any area agency on aging submitting a plan under this title, to

any provider of (or applicant to provide) services;

(8) issues guidelines applicable to grievance procedures required by section

306(a)(10); and

10

OEI.02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 36
APPENDIX

(G) affords an opportunity for a public hearing, upon request, by an area agency on

aging, by a provider of (or applicant to provide) services, or by any recipient of services

under this title regarding any waiver request, including those under Section 316.

(6) The State agency wil make such reports, in such form, and containing such

information, as the Assistant Secretary may require, arid compiy with such requirements

as the Assistant Secretary may impose to insure the correctness of such reports.

(8)(A) No supportve services, nutrition services, or in-home services are directly'

provided by the State agency or an area agency on aging in the State, unless, in the

judgment of the State agency-

(i) provision of such services by the State agency or the area agency on aging is

necessary to assure an adequate supply of such servces;

(ii) such services are directly related to such State agency's or area agency on aging's

administrative functions; or .

(ii) such services can be provided more economically, and with comparable quality, by

such State agency or area 'agency on aging.

Signature and Title of Authorized Offcial Date

11

OEI-02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 37
APPENDIX

ATTACHMENT B

STATE PLAN PROVISIONS AND INFORMATION REQUIREMENTS

. The following provisions and information requirements are listed in the indicated

sections of the Older Americans Act, as amended in 2000. State Plans may address

the provisions and information requirements in a format determined by each State.

This attachment, along with requirements listed in the State Plan Guidance Program

Instruction (PI) and attchment A, State Plan Assurances and Required Activities, make

up the package of instrctions for development of State Plans. Italicized notes are

provided for the State agency's convenience as links to referenced citations.

Section I. State Plan Information Requirements

Information required by Sections 102,305,307 and 705 that must be provided in the

State Plan:

102(19)(G) - (required only if the State funds in-home servces not already defined

in Sec. 102(19)) The term "in-home services" includes other in-home services as

defined by the State agency in the State plan submitted in accordance with Sec. 307.

Section 305(a)(2)(E)

The State agency shall provide assurance that preference wil be given to providing

services to older individuals with greatest economic need and older individuals with

greatest social need, with particular attention to low-income minorit individuals and

older individuals residing in rural areas and include proposed methods of carryng out

the preference in the State plan;

Section 307(a)

(2) The plan shall provide that the State agency wil:

(e) Specify a minimum proportion of the funds received by each area agency on aging

in the State to carry out part B that wil be expended (in the absence of a waiver under

sections 306(b) or 316) by such area agency on aging to provide each of the categories

of services specifed in section 306(a)(2) (Note: those categories are access, in-home,

arid legal assistance).

Section (307ra)(3)

The plan shall:

OEI-02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 38
APPEND X

(A) include (and may not be approved unless the Assistant Secretary approves) the

statement and demonstration required by paragraphs (2) and (4) of section 305(d)

(concerning distribution of funds); (Nole: the Ustalement and dømonstrationø are the

numerical statement of the intrastalø funding formula, and a demonstration of the

allocation of funds to each planning and service area)

(B) with respect to services for older individuals residing in rural areas:

(i) provide assurances the State agency wil spend for each fiscal year of the plan, not

less than the amount expended for such services for fiscal year 2000.

(ii) identify, for each fiscal year to which the plan applies, the projected costs of

providing such services (including the cost of providing access to such services).

(ii) describe the methods used to meet the needs for such services in the fiscal year

preceding the first year to which such plan applies.

Section 307(a)(8)) (Include in plan if applicable)

(B) Regarding case management services, if the State agency or area agency on aging

is already providing case management services (as of the date of submission of the

plan) under a Slate program, the plan may specify that such agency is allowed to

continue to provide case management serviCes.

(C) The plan may specify that anarea agency on aging is allowed to directly provide

information and assistance services and outreach.

Section 307(a)(10)

The plan shall provide assurance that the special needs of older individuals residing in

rural areas are taken into consideration and shall describe how those needs have been

met and describe how funds have been allocated to meet those needs.

Section 307(a)(15)

The plan shall, with respect to the fiscal year preceding the fiscal year for which such

plan is prepared-

(A) identify the number of low-Income minority older individuals in the State; and

(B) describe the methods used to satisfy the service needs of such minority older

individuals.

2

OEI.02.04.00290 ~OST SHARING FOR OLDER AMERICANS ACT SERVICES 39
APPEND X

Section 307(a)(21)

The plan shall:

(8) provide an assurance that the State agency wil pursue activities to increase access

by older individuals who are Native Americans to all aging programs and benefits

provided by the agency, including programs and benefits provided under this title (tite

11), if applicable, and specify the ways in which the State agency intends to implement

the activties.

Section 705(a)(7)

In order to be eligible to receive an allotment under this subtitle, a State shall include in

the State plan submitted under section 307:

(7) a description of the manner in whIch the State agency wil carry out this title in

accordance with the assurances describe in paragraphs (1) through (6). (Note:

Paragraphs (1) of through (6) of this section are listed below)

In order to be eligible to receive an allotment under this subtitle, a State shall include in

the State plan submited under section 307:

(1) fin assurance that the State, in carrying out any chapter of this subtite for which the

State receives funding under this subtitle, wifl establish programs in accordance with the

requirements of the chapter and this chapter;

(2) an assurance that the State will hold public hearings, and use other means, to obtain

the views of older individuals, area agencies on aging, recipients of grants under tite Vi,

and other interested persons and entities regarding programs carried out under this

subtitle;

(3) an assurance that the State, in consultation with area agencies on aging, will identify

and prioritize statewide activities aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefis and rights;

(4) an assurance that the State wifl use funds made available under this subtitle for a

chapter in addition to, and will not supplant, any funds that are expended under any

Federal or State law in existence on the day before the date of the enactment of this

subtite, to carry out each of the vulnerable elder rights protection activities described in .

the Chapter;

(5) an assurance that the State will place no restrictions, other than the requirements

referred to in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entiies

for designation as local Ombudsman enüties under section 712(a)(5);

(6) an assurance that, with respect to programs for the prevention of elder abuse,

neglect, and exploitation under chapter 3-

(A) in carrying out such programs the State agency wil conduct a program of services

consistent with relevant State law and coordinated with existing State adult protective

service activities for:

(i) public education to identify and prevent elder abuse;

(ii) receipt of reports of elder abuse;

3

OEI.02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 40
APPEND X

(Iii) active participation of older individuals participating In programs under this Act

through outreach, conferences, and referral of such individuals to other social servce

agencløs or sources of assistance. if appropriate and if the Individuals to be referred

consent; and

(iv) referrl of complaints to law enforcement or public protective service agencies if

appropriate;

(8) the State will not permit involuntary or coerced participation in the program of

servlcesdesCrbød in subparagraph (A) by alleged victims, abusers, or their

households; and

(e) all information gathered In the course of receiving reports and making røferrals

shall remain confidential except- .

(i) If all parties to such complaint consent in writing to the release of such Information;

(íi) If the release of such information is to a law enforcement agency, public protective

service agency, licensing or certifcation agency, ombudsman program, or protection or

advocacy system; or

(iii) upon court order.

4

OEI.02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 41
~ ACKNOWLEDGMENTS

This report was prepared under the direction of Jodi Nudelman,

Regional Inspector General for Evaluation and Inspections in the New

York regional office. Other principal Offce of Evaluation and

Inspections staff who contributed include:

Nancy Harrison, Team Leader

Elizabeth Jones, Program Analyst

Thomas Zimmermann, Program Analyst

Lekesha Campbell, Program Analyst

Ayana Everett, Program Specialist

Elise Stein, Director, Public Health and Human Services Branch

Technical Assistance

Barbara Tedesco, Mathematical Statistician

OEI.02.04.00290 COST SHARING FOR OLDER AMERICANS ACT SERVICES 42