PACE FAQ

• What is PACE?

  PACE, the Program of All-inclusive Care for the Elderly offers a benefit package that combines medical care, long-term care and prescription drugs to help frail and disabled individuals age 55 and older live as independently as possible for as long as possible within the community.

• Who assists me when I join PACE?

  When you enroll in the Community Care PACE program, you will be assigned to an interdisciplinary care team. Your team of health care and long-term care professionals will complete an assessment and work with you to develop a cost-effective care plan that uses natural supports or paid services from our provider network which meets your needs and identifies your outcomes. Your team will help coordinate and authorize the services you need.
  
  The care team consists of:

  • Primary Care Physician
  • Nurse Practitioner
  • Registered Nurse
  • Social Worker
  • Rehabilitation Therapists
  • Recreational Therapist
  • Dietician
  • Day Center Manager
  • Home care Coordinator
  • Transportation Coordinator
  • Personal Care Workers

   

• What is covered in the PACE benefit package?

  The PACE program covers medical care, long-term care, prescription drugs and some over-the-counter medications. You will receive additional services if they are part of your care plan and authorized by your team. Such services may include dental, vision and hearing care, therapy services, activities in our adult day centers, durable medical equipment and supplies, supportive home care, residential services and transportation. Your team will work with you to determine your needs and authorize the services that you receive.
  
  For more information, visit our PACE Services & Benefits page or refer to the PACE Enrollment Agreement & Member Handbook.

• How are decisions about my care made?

  Decisions about your health care, long-term care and medications are made by you and your team of healthcare professionals, who are committed to providing quality care to keep you as healthy as possible. Your team may also use Resource Allocation Decision Method (RAD) to identify the best way to meet your needs and which supports and services to authorize.  

• Can I choose my own providers?

  Community Care employs its own staff of highly skilled primary care physicians to serve members. If you are in need of a specialist outside of the team, you will work with your care team to select service providers from our extensive provider network. You may also choose to have more responsibility and be more involved in managing your long-term care services through our self-directed supports option.

• What rights do I have in the PACE program?

  First and foremost, you have the right to be treated with respect and dignity. You also have the right to receive information about your services and have that information protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Additionally, you have the right to make decisions about your health care. Your care team is responsible to help you understand your rights and to ensure those rights are protected.

• What if I disagree with a decision made regarding my services?

  Member satisfaction is extremely important to Community Care. You always have the right to appeal if you disagree with a decision that stops or reduces a service or suspends a Medicaid service. If you are unhappy with the services you receive, you may file a grievance. There are several ways to file an appeal or grievance. Your team will help you understand your grievance and appeal rights and our Member Rights Specialists are available to assist you through the grievance or appeal process.
  

• What do I need to do if I become a member?

  Your participation in developing and following your care plan is essential to achieving your goals. As a member, you'll need to keep your care team up-to-date on changes in your condition or if you change your residence. Members must also use providers within our network, receive approval from the care team prior to receiving services and make timely payments for any costs for which they are responsible.

• What payments am I responsible for?

  The absence of copays and deductibles are a major benefit to the PACE program. Based on your income, you may have a monthly cost share or spend down to remain eligible for Medicaid. You may also have to pay for your room and board each month. Cost share or spend down and room and board are two different things. It is possible that you may have to pay for both.

• Am I eligible to become a member of the Community Care PACE program?

  To be eligible for PACE, you must be:
  
  55 years of Age or Older
  
  A Milwaukee County, Racine, or Waukesha County Resident
  
  Functionally Eligible
  As determined by the Wisconsin Adult Long-term care functional screen.
  
  Financially Eligible for
  

  • Wisconsin Medicaid, or
  • Medicare and able to pay the monthly premium, or
  • both Medicaid and Medicare, or
  • Neither Medicaid or Medicare but able to pay for the program out of pocket.

  In order to enroll in our PACE program, you'll need to contact your local Aging and Disability Resource Center (ADRC).

• What are my rights and responsibilities at disenrollment?

  You must continue to get services through Community Care PACE until your membership ends.
  You must continue to pay any monthly costs on time, including premiums and/or room and board charges.
  Community Care PACE must continue to furnish all needed services until your membership ends.

• How do I appoint a representative?

  How to appoint a representative, click to access form.