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Program of All-Inclusive Care for the Elderly (PACE) is operated by Health First Colorado (Colorado's Medicaid Program) and Medicare. The PACE program provides comprehensive medical and social services to certain frail individuals 55 years of age and older. The goal of PACE is to help individuals live and stay in their homes and communities through comprehensive care coordination.
PACE also includes any services determined medically necessary by your team of health care professionals to improve and maintain your overall health.
Your interdisciplinary team will develop a care plan with you and anyone you designate, to coordinate all the services you need to stay safely in your community. Your interdisciplinary team will arrange for you to receive services within a PACE Center or through providers within the PACE network. You may have to choose a new primary care provider within the PACE network. Your primary care provider and interdisciplinary team will complete regular assessments of your health needs to help you stay safely in your community.
Who has a say in my treatment?
You and/or your authorized representative have the primary say!
Your PACE doctor and other care providers are the people who work with you to make decisions about your care. You, your doctor and other care providers agree on what is best for you. If you disagree with your interdisciplinary team about your care plan, you have the right to appeal.
If your request for service is denied or a service is reduced or suspended, you may appeal that decision through an impartial third party provided through your PACE provider, a Medicaid Administrative Law Judge, or the Medicare Independent Review Board, if Medicare eligible. To file an appeal, contact your social worker, case manager or the PACE ombudsman.
If you have a complaint about the quality of services received, you may file a grievance with the PACE provider. To file a grievance, contact your social worker or the PACE ombudsman.
You may be able to get PACE program benefits and services at no cost, or you may have to pay a monthly payment. Some participants may pay a monthly premium based on income. For some, the premium can be paid for by Health First Colorado and Medicare. There are no co-payments or out-of-pocket expenses for PACE covered services. You may be able to use some of your income for medical expenses not covered by Health First Colorado or other insurance, like hearing aids, eyeglasses and health insurance premiums, this is called a Personal Needs Allowance (PNA). Contact your eligibility site or PACE organization if you have questions about your premium or personal needs allowance.
You must contact the PACE program in your area to apply. Below are the PACE organizations in Colorado and the areas they serve.
If you need help finding a provider, understanding your benefits, or have more questions about this program, please contact your local Single Entry Point agency, PACE Organization or the Health First Colorado Member Contact Center. If you have questions about your health care, please talk with your doctor.
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