What is PACE?
The Program of All-Inclusive Care for the Elderly is a program of the Commonwealth of Virginia, the Federal government, and Appalachian Agency for Senior Citizens. PACE offers a long-term care solution for older adults that is an alternative to nursing facilities. The program is sponsored by Medicare, Medicaid and private pay funds to provide a full spectrum of services administered and coordinated by a PACE Interdisciplinary Team. PACE is designed to help older adults remain independent in the community as long as is medically feasible by providing services to participants at home, at the PACE center and in the hospital.
Participants can be picked up at their home and transported to the PACE Center on scheduled days. At the center, they may be scheduled to receive medical care, therapy and social activities. Participants eat a hot lunch and may receive a morning and afternoon snack. Participants will also be transported, at no cost, to their specialty medical appointments as authorized. The PACE Interdisciplinary Team must authorize all services except emergency care.
The AASC PACE health care team is available to meet your care needs 24 hours a day, 7 days a week.
Eligibility
AASC’s PACE programs are AllCARE for Seniors and Mount Rogers PACE. These programs serve adults 55 years of age or older who, at the time of enrollment:
• are eligible for nursing facility level of care.
• are able to live safely at home and in the community with support.
• live in a PACE service area.
AllCARE for Seniors serves the counties of Buchanan, Dickenson, Russell and Tazewell.
Mount Rogers PACE serves the counties of Bland, Smyth, Wythe and Washington and the city of Bristol.
Cost
When an individual enrolls in PACE, they agree to receive their health care through our program, including primary care and specialty physician services (other than emergency services). PACE is a non-profit program funded through a contract with Medicare and Medicaid. Some participants choose to pay privately for PACE, though they still need to meet all eligibility requirements.
PACE services are covered in part or in whole by Medicare and Medicaid. Participants who have both Medicare and Medicaid have no deductibles or co-payments, but may need to pay a set premium each month to stay eligible for Medicaid. Participants will be notified in advance if they need to pay a premium. If they have Medicare ONLY, they must pay a monthly premium to participate in PACE. If they have NEITHER Medicaid nor Medicare, they must pay our full monthly premium.
Appointing a Representative for Medicare
CMS allows individuals to appoint representatives who can exercise their rights to appeal an initial decision.
An appointment of a representative must:
• be in writing.
• be signed and dated by both the party and the individual agreeing to be the representative.
• provide a statement appointing the representative to act on behalf of the party, and in the case of a beneficiary, authorize the adjudicator to release personally identifiable health information.
• include in written explanation of the purpose and scope of the representation.
• contain both the party and the appointed representative’s name, phone number, and address.
• provide the beneficiary’s Medicare health insurance claim number, if applicable. When the represented party is not a beneficiary, a unique identifier (such as the National Provider Identifier or Plan Number) is requested.
• include the appointed representative’s professional status or relationship to the party.
• be filed with the entity processing the party’s initial determination or appeal.
• CMS Form 1696 must be completed. (Click here to go to printable PDF of CMS 1696 form)
Filing a grievance and appeal
AASC PACE strives to make sure participants are satisfied with the care they receive from the program. If there is a problem or concern about any aspect of the program, please contact AASC PACE right away through one of the following methods:
• Orally by informing an employee or by calling 276-964-7176 (AllCARE for Seniors) or 276-781-9050 (Mount Rogers PACE). Participants may also call these numbers for process or status questions.
• Written by fax at 276-964-7157 (AllCARE for Seniors) or 276-706-8100 (Mount Rogers PACE) or by mail at P.O. Box 765, Cedar Bluff, VA 24609
A participant will never be discriminated against for filing a grievance or an appeal.
Once the participant or their family member has filed a grievance, AASC’s PACE program will discuss it with the participant or their representative and provide the specific steps, including the time frames for response, that will be taken to resolve the grievance, which includes a written notification of the grievance process. PACE will continue to furnish all services at the frequency provided in the current plan of care during the grievance process. If the participant or their family member is still not satisfied with the resolution proposed by the team, the participant will be informed, orally and in writing, of what action that may be taken.
A participant has the right to file an appeal based on any decision by the Interdisciplinary Team to deny, reduce, or refuse to pay for a particular service that they wish to receive. If the participant wishes to file an appeal, they must make a request for the appeal within thirty (30) days of an AASC PACE decision to deny, reduce, or refuse to pay for a particular service.
Disenrollment
A participant may leave PACE for any reason at any time. Speak with a team member regarding this decision. If a participant chooses to disenroll verbally, they must sign a disenrollment form. After disenrolling from PACE, a participant can resume benefits in the traditional Medicare and Medicaid programs at the beginning of the following month. A participant may be involuntarily disenrolled from PACE for certain reasons, such as moving out of the service area or refusing to follow the approved plan of care.
Placing you at the center
With PACE, the focus is on the participant. An Interdisciplinary Team of medical and social care professionals with expertise in multiple areas works closely to ensure comprehensive plans of care for participants. Care is tailored to specific needs with an aim of enabling participants to live safely in their own home as long as possible. Services include but are not limited to:
• Medically necessary transportation (wheelchair accessible)
• Hospital care as needed and coordinated by the Interdisciplinary Team at PACE
• Outpatient medical services: lab work, X-rays and other tests will be scheduled as needed
• Care from medical specialists in cardiology, ophthalmology, dermatology, orthopedics, wound care, surgery, podiatry, audiology and more
• Adult day care
• Rehabilitation and therapy services
• Durable medical equipment
• All necessary prescription medications
• Nutritional services
• Respite services
• Meals
• Personal emergency response as needed
• Personal or home care services
PACE is contracted with a wide range of providers including specialists, therapists and other medically needed providers who are readily accessible. Through these services, PACE approaches the participant’s care with a focus on individualized needs. PACE schedules all medical appointments to reduce the scheduling burden on participants and caregivers.
The program also helps with emotional, social and other challenges that older adults may face. AASC PACE strives to offer activities and services to give a better quality of life to the participants.
Important Links
• Virginia Department of Medical Assistance Services
• Centers for Medicare and Medicaid Services – PACE information
• National PACE Association
• Medicare
Contact AASC PACE
AllCARE for Seniors
Physical Address: 216 College Ridge Road, Cedar Bluff, VA 24609
Phone: 276-964-7176
Toll Free: 866-828-7723
TDD/TTY: 276-964-5765
Fax: 276-964-7157
Mount Rogers PACE
Physical Address: 555 South Main Street, Marion, VA 24354
Phone: 276-781-9050
Toll Free: 888-500-0130
TDD/TTY: 276-964-5765
Fax: 276-706-8100
Page Updated: September 2, 2022
CMS/SAA Approved 2022