PATHWAYS Pace

The Program of All-Inclusive Care for the Elderly (PACE) coordinates the care of each participant enrolled in the program based on his or her individual health care needs. The goal is to enable nursing home eligible older individuals to remain living in their homes and communities for as long as it is safely possible.

A person qualifies if she or he:

• Is 55 years of age or older.
• Meets the requirement for skilled nursing home care as determined by Colorado PACE’s interdisciplinary team (IDT) assessment and certified by the Colorado Department of Human Services.
• Lives in a service area (county and zip code) served by the Colorado PACE program.
• Can live in the community without jeopardizing his/her health or safety.

Yes. If a person meets the income and assets limits to qualify for Medicaid, the program pays for a portion of the monthly Pathways 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. Pathways PACE staff can help determine a person’s Medicaid eligibility.

The Pathways PACE program is both Medicare providers and long-term care providers. By enrolling in the Pathways PACE program, you will no longer be enrolled in a traditional Medicare/HMO plan if you have one.

Pathways PACE participants agree to receive all health care services defined in a participant’s individualized care plan developed by the PathwaysPACE program’s Interdisciplinary Team (IDT). Pathways PACE IDT members include the primary care provider, registered nurse, social worker, physical, occupational, and recreational therapists, dietitian, home care coordinator, personal care attendant, transportation driver, and center director.

If you have a specialist that is part of the Pathways PACE network of contracted providers, you may be able to keep your current specialty care physician. When a participant enrolls in a Pathways PACE health plan, she/he is assigned a primary care physician (PCP) who is a member of the Pathways PACE Day Center’s Interdisciplinary Team (IDT) skilled in treating the healthcare needs of seniors.

Pathways PACE participants may be fully and personally liable for the costs of unauthorized or out of Pathways PACE program agreement services.

Enrollment into Pathways PACE includes four steps:

1: Referral and Intake
2A: Financial Information
2B: Functional Eligibility Determination
3: Assessment
4: Enrollment

Pathways PACE programs provide transportation to the Day Center. Transportation is a key part of the Pathways PACE benefit. Transportation is not only provided between the home and the Day Center, but also to appointments with specialists and other activities that are included in each Pathways PACE participant’s individualized care plan.

At the Pathways PACE Day Center, a participant may see a care provider in the clinic, have lunch, enjoy social activities, and receive therapies before being taken back to their home and the end of the day.

No, that is not recommended. Focusing on a single aspect of care does not provide seniors in the Pathways PACE program with the best chance of remaining independent in the community. For example, a participant may need rehabilitation after a stroke, which could include a special diet or medications for hypertension, diabetes, and other chronic problems. A participant may also feel lonely and isolated. The Pathways PACE program can address these problems through a team of experienced healthcare professionals and a treatment plan that focuses on a participant’s complete health care picture.

Not usually. On average, Pathways PACE participants attend the Day Center two to three times a week. Pathways PACE Day Center attendance is based on the needs defined in a participant’s individualized care plan and can range from once a week to several days a week, as needed.

The goal of Pathways PACE is to keep participants out of a skilled nursing facility as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, Pathways PACE will pay for the care and supervision will continue to be provided by the Pathways PACE Interdisciplinary Team.

Pathways PACE participants are free to disenroll from PACE at any time and resume their benefits in the traditional Medicare and Medicaid programs. You can enjoy PACE benefits until the end of the month in which you disenroll.