What does PACE stand for?
PACE stands for “Program of All-inclusive Care for the Elderly.” PACE is a comprehensive, coordinated health care program sponsored by Medicare, Medicaid and private funds, which provide medically necessary care and services.
Are there Financial Requirements for PACE?
More than 90% of participants are enrolled in both Medicaid and Medicare. To qualify for Medicaid, an individual must meet income and asset eligibility requirements and provide proof of the inrformation in a Medicaid Application.
How do I qualify for PACE Central Michigan?
To be eligible for our program, you must be 55 years of age or older, certified by the State of Michigan to need nursing home care, able to live safely in the community at the time of enrollment with the support of PACE Central Michigan and live in the PACE Central Michigan service area.
Can I Still Enroll with PACE if I don't Qualify for Medicaid?
Yes. If a person does not meet the income and asset limits to qualify for Medicaid, they may pay out of pocket for services normally covered by Medicaid and Medicare covers the cost of their services. PACE program staff can help determine a person's Medicaid eligibility.
How do I get started with PACE Central Michigan?
The process begins with a home visit by our Enrollment Specialist with you and the family that you choose to include. A brief discussion of your eligibility and your health status occurs. If it appears you may qualify, a PACE Home Care Team provides an evaluation of your care needs and will arrange a visit to the PACE CENTER for you to meet and receive assessments from the PACE Central Michigan doctor, nurses, social workers and other members of the PACE team. Following enrollment, you will receive a personalized plan of care that includes the services you will receive.
What happens if I have a health problem at night?
PACE Central Michigan provides access to the necessary care you need 24 hours a day, 7 days a week.
How do I get to PACE Central Michigan?
Once you are enrolled, transportation is provided by PACE Central Michigan to the day health center, appointments to medical specialists and activities arranged and approved by our interdisciplinary team. A specially equipped bus picks you up at home and brings you to the day health center. Families may also choose to transport their loved ones to PACE Central Michigan.
What happens if I want to leave PACE?
You are free to disenroll from PACE and resume your benefits in traditional Medicare and Medicaid programs at any time.
Do I have to give up my current doctor if I enroll in PACE?
When you enroll with PACE Central Michigan, our physician will become your primary care doctor. You will have the chance to meet with the PACE physician who will be serving you when you come to the Center before joining the program. PACE Central Michigan allows you to continue to see your current doctor up to twice a year for consultation; however, the PACE physician is the sole provider who can prescribe medications and authorized care and services.
Please note that PACE may refer you to other providers, such as specialists, and assures access to necessary services but does not guarantee access to a specific provider.
What is a grievance and how do I file a grievance?
A grievance is a complaint, either written or oral, expressing dissatisfaction with the services or the quality of your care provided by PACE Central Michigan. You may file a grievance with any PACE staff member at any time. Grievances can be filed in person, fax, mail, or telephone. To file a grievance by telephone or for status updates and process questions regarding a filed grievance, please contact our Quality Manager at (989) 953-5810. Other options include:
- In person or by Mail; Attention: Quality Manager, PACE Central Michigan, 1750 East Bellows Street, Mt Pleasant, MI 48858.
- By Fax (989) 953-5801
What if I’m not satisfied with the result of a Grievance?
You or your representative have the right to request an appeal of PACE Central Michigan’s decision. If PACE denies a request for services or payment or reduces your services, you will receive written information about the denial and how to file an appeal. There are two types of appeals; internal and external through the Medicare and/or Medicaid appeals process.
Internal appeals are received either verbally or in writing to PACE Central Michigan. An appeal must be submitted within 30 days from the day that you are notified that your request has been discontinued, reduced, or denied. Until you receive notice of a final decision, you may choose to continue to receive any services in question, but you may have to pay for these services if the final decision is not in your favor. You also have the right to file an appeal with the State of Michigan at the same time of filing through PACE Central Michigan. You have the right to request an expedited appeal.
You can file an external appeal to either Medicare or Medicaid, but not both. PACE staff will assist you, at your request, with an external appeal. To appeal to Medicaid, you may contact:
- Michigan Administrative Hearing System, PO Box 30763, Lansing, MI 48909. (877) 833-0870
Regarding filing an appeal with Medicare, you need to go through the PACE Central Michigan appeal process first. PACE Central Michigan staff will help file with Medicare if that is your choice.
Can I appoint someone to help me file a grievance or appeal?
If you would like to appoint a person to file a grievance or request an appeal on your behalf, you and the person accepting the appointment must complete the CMS Appointment of Representative Form (or a written equivalent) and submit it with the request. You can download the form with instructions from the following link:
Stay in the home you love, see us for the care you need.
Our goal is to provide our frail senior community members with the care, medical treatment and support they need to achieve the highest quality of life - while staying independent as long as possible. Our elder care experts offer an alternative to nursing home placement that features comprehensive, coordinated care
For more information about PACE Central Michigan,
or to speak to one of our elder care representatives,
please call the number below