2028 Private Pay Services | ADMINISTRATION-5600-MANUAL
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Georgia Division of Aging Services |
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Chapter: |
2000 Fund Sources and Budget Types |
Effective Date: |
12/05/2023 |
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Section Title: |
Private Pay Services |
Reviewed or Updated in: |
MT 2024-02 |
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Section Number: |
2028 |
Previous Update: |
MT 2014-04 |
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Summary Statement
AAAs and their providers are encouraged to develop private pay services wherever feasible and possible in order to expand the service delivery network and to ensure its sustainability.
Basic Considerations
Private payment for services occurs when individuals pay the full cost of the services they receive. Because there is no public funding involved, private pay services are not subject to the ‘cost sharing' provisions under the Older Americans Act (OAA §315(a) at 42 U.S.C.§ 3030c-2(a)). Any service for which cost sharing is strictly prohibited by OAA or state guidelines may be offered on a private pay basis.
AAA staff may offer applicants for home and community-based services the opportunity to pay the full cost of services in order to obtain assistance in a more timely manner if they would otherwise be waitlisted for admission to services.
Development of Private Pay Service Model
The following guidance will help the AAA in developing a private pay service model.
Organizational Capacity
Describe the type of organization and its activities, factors that differentiate the organization from others, markets currently served and the organization’s infrastructure and its assets/deficits that impact development of private pay services.
Service or Product
Describe the service(s), product(s) or expertise/knowledge that the AAA provides, how the service or product benefits others, the product’s life cycle, the desired market segment, the quality standards desired for the product/service and evaluation methods, and the role of customer service in product delivery.
Market Analysis
Describe the industry, service market, potential market saturation/appeal, and competitors.
Financial Projections
Describe the actual cost of the service or product (the Uniform Cost Methodology will help determine actual costs), the retail cost that the market will bear, the “break even” point per unit and per service or product line, and how start-up funds are to be acquired and managed.
Termination for Non-Payment of Private Pay Fees
AAAs/providers shall assure that adequate policies and procedures are implemented to address potential termination of services for non-payment of fees assessed for private pay services.
An older person or a person with a disability who has an established relationship with a service provider on a private pay basis but who can no longer private pay for services should not be abandoned. The provider must make every effort to provide linkage with a community agency suited to the client’s needs.
Refer to Section 2025.