The following Frequently Asked Questions and answers will help you learn more about PACE. You can also call PACE Central Michigan during normal business hours to speak with an Enrollment Specialist who will answer all of your questions about PACE.
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.
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 information in a Medicaid Application.
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.
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.
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 will meet with you to evaluate your care needs. They will then arrange a visit to the PACE CENTER for you to meet our team and for our team to further assess your needs. Following enrollment, you will receive a personalized plan of care that includes the services you will receive.
PACE Central Michigan provides access to the necessary care you need 24 hours a day, 7 days a week.
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.
You are free to disenroll from PACE and resume your benefits in traditional Medicare and Medicaid programs at any time.
When you enroll with PACE Central Michigan, our provider will become your primary care provider. You will have the chance to meet with the PACE provider before joining the program. PACE Central Michigan allows you to continue to see your current provider up to twice a year for consultation; however, the PACE provider 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.
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
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, you will receive written information about the denial and how to file an appeal.
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 denied. Until you receive notice of a final decision, you may choose to continue to receive any services in question (if reduced or discontinued), 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 as 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 Office of Administrative Hearing and Rules, 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.
If you would like to appoint a person to submit a request or file 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:
Schedule a tour of our adult day health center or join our program. Fill out the form or call us at (989) 953-5814Inquire Today
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