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FREQUENTLY ASKED QUESTIONS

Who qualifies for PACE programs in Michigan? Can I keep my own doctor? Find answers to these questions and more below!

We’re sure you’ve got plenty of questions about Thome PACE: who we are, what we do, and what your loved one stands to gain by enrollment in our program. We’re happy to help. Find answers to questions like: “Who qualifies for PACE,” “If I want to join PACE, what do I do next,” and more below.

FAQ

Who qualifies for PACE programs in Michigan? Can I keep my own doctor? Find answers to these questions and more below

We’re sure you’ve got plenty of questions about Thome PACE: who we are, what we do, and what your loved one stands to gain by enrollment in our program. We’re happy to help. Find answers to questions like: “Who qualifies for PACE,” “If I want to join PACE, what do I do next,” and more below.

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What is PACE?


PACE is a Program of All-Inclusive Care for the Elderly. The goal of PACE is to help older adults remain living in their community as independently as possible for as long as possible. We do this by providing a comprehensive package of medical, wellness and support services.




How do people qualify for PACE?


A person qualifies if she or he:

  • Is 55 years of age or older
  • Lives in the service area of a PACE organization
  • Meets the level of care requirements as determined by the State of Michigan (As determined by the PACE eligibility team; see the list of commonly qualifying conditions here.)
  • Is able to live safely in the community with the support of PACE services when joining




Are prescription drugs covered?


PACE is a Program of All-Inclusive Care for the Elderly. The goal of PACE is to help older adults remain living in their community as independently as possible for as long as possible. We do this by providing a comprehensive package of medical, wellness and support services.




Are people who do not qualify for Medicaid eligible for PACE enrollment?


Yes. If a person meets the income and asset limits to qualify for Medicaid, the Medicaid program pays a monthly PACE® premium. Medicare pays for the rest. If a person does not qualify for Medicaid, he or she is responsible for the portion of the monthly premium Medicaid would pay. PACE program staff can help determine a person’s Medicaid eligibility.




If I belong to a Medicare HMO, can I also enroll in PACE? for long-term care services?


You can only enroll in one Medicare health plan. PACE health plans are both Medicare providers and long-term care providers. By enrolling in a PACE health plan you will be automatically dis-enrolled from your current Medicare/HMO.




Can I keep my own doctor?


When a person enrolls in a PACE health plan, she or he is assigned a primary care physician who is part of an interdisciplinary team skilled in treating the problems of the aging. This primary care physician works with other members of the team to coordinate all services a member receives. In some circumstances, participants may be able to visit a former primary care physician when approved by the PACE Interdisciplinary Team. Additionally, participants may continue to receive care from their speciality providers.




How do people get to the Day Health Center?


PACE programs provide transportation to the day health center. Transportation is a key part of the PACE benefit. Transportation is not only provided between the home and the day health center, but also to appointments with specialists and other activities as recommended by the interdisciplinary team.




Can I just use a specific service such as home care, meals, transportation or the Day Health Center?


Focusing on a single aspect of care does not provide the participant with the best chance of remaining independent in the community. Upon enrolling in PACE, the Interdisciplinary Team develops an individualized plan of care to provide the participant with a comprehensive health and wellness plan, integrating a variety of services.




Do PACE participants attend the Day Center every day?


No. On average, PACE participants attend the day center three times a week. Day center attendance is based on individual needs and can range from once a week, to several days a week, as recommended by the interdisciplinary team.




What happens if a PACE participant needs nursing home care?


The goal of PACE is to keep participants out of a nursing home as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, PACE will pay for the care and the supervision of the interdisciplinary team will continue.




If I want to join PACE, what do I do next?


  • Consult the National PACE Program Locator on the National PACE Association website to determine if PACE is available in the area in which you reside.
  • Contact PACE plan so they can schedule a home visit with you and your caregiver to tell you more about their plan.
  • Attend a tour of the PACE site with your family/caregiver(s).
  • The PACE plan will then schedule a complete medical and social assessment for you by their interdisciplinary team.




What happens if a person wants to leave PACE?


A PACE participant is free to disenroll from PACE® and resume their benefits in the traditional Medicare and Medicaid programs at any time. Disenrollment requests are processed as quickly as possible by Medicare and Medicaid.




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 Thome PACE. 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 Center Manager at 517.768.9791. Other options include:

In person or by Mail:

Thome PACE
Attention: Center Manager
2282 Springport Rd.
Jackson, MI 49202

Or by Fax: 517.783.5223

Downloadable Grievance Form




What if I’m not satisfied with the result of a Grievance?


You or your representative have the right to request an appeal of Thome PACE’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 Thome PACE. 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 North. You have the right to request an expedited appeal.

You can file an external appeal to either Medicare or Medicaid, but not both. Thome 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

Phone: (877) 833-0870

Regarding filing an appeal with Medicare, you need to go through the PACE North appeal process first. PACE North staff will help file with Medicare if that is your choice.

Download Participant Appeal Form




Can I appoint someone to help me file a grievance or appeal?


Yes. 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:

Appointment Representative Form (Internal)

Appointment Representative Form (External)




What is the cost for Thome PACE?


The program is funded by Medicare, Medicaid and/or private funds. For those who qualify for Medicaid, Thome PACE costs nothing (no copays, deductibles, spend-downs, or donut holes). We encourage anyone to call us to discuss Medicaid eligibility, as we find that many people don’t know they qualify for assistance. PACE participants may be fully and personally liable for the costs of unauthorized or out-of-PACE program agreement services (except in emergency services).

Individuals are not required to have Medicare and Medicaid for enrollment. Please contact us to discuss the monthly cost of our all-inclusive care at 517-768-9791.





Still have questions?