Last modified on September 18th, 2023 at 07:29 pm
We Provide Preventative, Primary, Acute, and Long-term Care Services So That Older Adults Can Continue Living Safely Independently. PACE (Program of All-Inclusive Care for the Elderly) eligibility is determined by specific PACE enrollment criteria as dictated by the State of Colorado and the Centers for Medicare and Medicaid Services.
To Be Eligible For Senior CommUnity Care PACE, You Must Meet The Following Criteria:
• Be at least 55 years old
• Live in Senior CommUnity Care PACE service area (see below)
• Eligible for nursing home level of care as determined by the State of Colorado
• Able to live safely in the community with PACE services at the time of enrollment
Senior CommUnity Care provides services to older adults within these Montrose and Delta County zip codes:
81401, 81403, 81410, 81413, 81415, 81416, 81418, 81419, 81425, 81428
Costs Of Service
Senior CommUnity Care Pace is designed to utilize Medicare and Medicaid funds to provide Coordinated Healthcare, Social Engagement, Medication Management, Transportation, In-Home Assistance and other Specialty care options. We can assist you in the application process for Medicaid.
A PACE organization may not charge a premium to a participant who is eligible for both Medicare and Medicaid, or who is only eligible for Medicaid.
A PACE organization may charge a premium to a participant who is only eligible for Medicare.
There is also a private pay option for participants who are not eligible for either Medicare or Medicaid.
The amount that a PACE organization can charge a participant as a monthly premium depends on the participant’s eligibility under Medicare and Medicaid. The PACE organization will provide a description of participant premiums, if any, and procedures for payment of premiums during the enrollment process.
- If you are eligible for Medicaid…no premium to the participant.
- If you are eligible for Medicare and Medicaid…no premium to the participant.
- If you are eligible for Medicare only…participants pay the Medicaid premium plus Medicare Part D.
- If you are not eligible for Medicare and Medicaid…participants pay the self-pay rate.
- While it is our goal to keep PACE participants in their residence…the only exception is if the individual lives in or moves to supportive housing (assisted living or nursing home), in which case there may be a co-pay to that facility.
Participant’s Bill of Rights & Responsibilities
Your Rights In The Program Of All-Inclusive Care For The Elderly
At Senior CommUnity Care, we are dedicated to providing you with quality health care services so that you may remain as independent as possible. Our staff seeks to affirm the dignity and worth of each participant by assuring the following rights:
The Program of All-Inclusive Care for the Elderly, also called PACE, is a special program that combines medical and long-term care services in a community setting.
When you join a PACE program, you have certain rights and protections. Senior CommUnity Care must fully explain your rights to you or someone acting on your behalf in a way you can understand at the time you join.
You have the right to be treated with respect.
You have the right to be treated with dignity and respect at all times, to have all of your care kept private, and to get compassionate, considerate care. You have the right:
• To get all of your health care in a safe, clean environment.
• To be free from harm, including physical or mental abuse, neglect, corporal punishment, involuntary seclusion, excessive medication, and any physical or chemical restraint imposed for purposes of discipline or convenience and not required to treat participants medical symptoms.
• To be encouraged to use your right in the PACE program.
• To get help, if you need it, to use the Medicare and Medicaid feedback and appeal
processes, and your civil and other legal rights.
• To be encouraged and helped in talking to Senior CommUnity Care staff about changes in policy and services you think should be made.
• To use a telephone while at the Day Center.
• To not have to do work or services for Senior CommUnity Care.
You have a right to protection against discrimination.
Discrimination is against the law. Every company or agency that works with Medicare and Medicaid must obey the law. They cannot discriminate against you because of
• Race / Ethnic Origin
• Mental or physical ability
• Sexual Orientation
• Source of payment for your health care (For example, Medicare or Medicaid)
If you think you have been discriminated against for any of these reasons, contact a staff member at the PACE program to help you resolve your problem. If you have any questions, you can call the Office for Civil Rights at 1-800-368-1019. TTY users should call 1-800-537-7697.
You have a right to information and assistance.
You have the right to get accurate, easy-to-understand information and to have someone help you make informed health care decisions. You have the following rights:
• To have someone help you if you have a language or communication barrier so you can understand all information given to you.
• To have Senior CommUnity Care interpret the information into your preferred language in a culturally competent manner, if your first language is not English and you cannot speak English well enough to understand the information being given to you.
• To get marketing materials and participant rights in English and in any other frequently used language in your community. You can also get these materials in Braille, if necessary.
• To get a written copy of your rights from the PACE program.
• Senior CommUnity Care must also post these rights in a public place in the Day Center where it is easy to see them.
• To be fully informed, in writing, of the services offered by Senior CommUnity Care. This includes telling you which services are provided by contracts instead of Senior CommUnity Care staff. You must be given this information before you join, at the time you join, and when there is a change in services.
• To look at, or get help to look at, the results of the most recent review of Senior CommUnity Care. Federal and State agencies review all PACE programs. You also have a right to review how Senior CommUnity Care plans to correct any problems that are found at an inspection.
To contact 1-800-MEDICARE for information and assistance, including to make a complaint related to the quality of care or the delivery of a service.
You have a right to a choice of providers.
You have the right to choose a health care provider within the Senior CommUnity Care network and to get quality health care. Women have the right to get services from a qualified women’s health care specialist for routine or preventive women’s health care services.
Additionally, you have the right to reasonable and timely access to specialists. You also have the right to receive necessary care in all care settings, up to and including placement in a long-term care facility.
You have a right to access emergency services.
You have the right to get emergency services when and where you need them without Senior CommUnity Care’s approval. A medical emergency is when you think your health is in serious danger – when every second counts. You may have a bad injury, sudden illness or an illness quickly getting much worse. You can get emergency care anywhere in the United States.
You have a right to participate in treatment decisions.
You have the right to fully participate in all decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you, you have the right to choose that person to act on your behalf. You have the right:
• To have all treatment options explained to you in a language you understand, to be fully informed of your health status and how well you are doing, and to make health care decisions. This includes the right not to get treatment or take medications. If you choose not to get treatment, you must be told how this will affect your health.
• To have Senior CommUnity Care help you create an advance directive. An advance directive is a written document that says how you want medical decisions to be made in case you cannot speak for yourself. You should give it to the person who will carry out your instructions and make health care decisions for you.
• To participate in making and carrying out your plan of care. You can ask for your plan of care to be reviewed at any time.
• To be given advance notice, in writing, of any plan to move you to another treatment setting and the reason you are being moved.
You have a right to have your health information kept private.
You have the right to talk with health care providers in private and to have your personal health care information kept private as protected under State and Federal laws. You also have the right to look at and receive copies of your medical records.
There is a new patient privacy rule that gives you more access to your own medical records and more control over how your personal health information is used. If you have any questions about this privacy rule, call the Office for Civil Rights at 1-800-368-1019. TTY users should call 1-800-537-7697.
You have a right to file a complaint.
You have a right to complain about the services you receive or that you need and don’t receive, the quality of your care, or any other concerns, or problems you have with Senior CommUnity Care through the feedback process. You have the right to a fair and timely process for resolving concerns with the Senior CommUnity Care program. You have the right:
• To a full explanation of the feedback process.
• To be encouraged and helped to freely explain your concerns to Senior CommUnity Care staff and outside representatives of your choice. You must not be harmed in any way for telling someone your concerns. This includes being punished, threatened, or discriminated against.
• To appeal any treatment decision by Senior CommUnity Care staff or contractors.
You have a right to leave the program.
If, for any reason, you do not feel that the PACE program is what you want, you have the right to leave the program at any time.
Grievances and Appeals
Our Participant Grievance and Appeal Process is Outlined Below
I. How to File a Grievance
Direct Contact Information For Grievances
- Oral Grievances may be submitted to any PACE staff member.
- Written Grievances:
Senior CommUnity Care PACE, 2377 Robins Way, Montrose, CO 81401, Attn: Quality Assurance Department
- Fax Grievances: 1.866.875.1251
- Contact number for participants, family members and/or representatives for Status questions, contact Debi English at DArterburn02@voa.org or by phone at 970-508-7755.
Colorado SAA Contact Information: PACE Program Administrator 1570 Grant St. Denver, CO 80203 Phone: (303) 866-2993 Fax: (303) 866-4411 TDD: 1-800-659-2656
II. How to File an Appeal
Click here to view our important information regarding the appeals process.