PATHWAYS PACE

The Enrollment Process

Enrollment into PATHWAYS PACE includes four steps:

The intake process begins when you, or someone on your behalf, contacts Pathways PACE. An Enrollment Specialist will visit with you to explain our program and obtain further information about you. During this visit:

• You will learn how the program works, and the kinds of services offered. You will receive answers to any questions you have about PACE.
• If you enroll, you must agree to receive all your health care services from Pathways PACE and our network of providers. Your primary care provider becomes a Pathways PACE primary care provider.
• You will sign release of information forms, which allow Pathways PACE to obtain your past medical records, allowing our team to fully assess your health conditions, as well as financial information and your eligibility status for Medicare and Medicaid.

The Pathways PACE Enrollment Specialist will discuss the various financial options available based on your financial situation. Options for payment include Medicare, Medicaid, or private pay.

• If you are eligible for Medicaid, or dually eligible for both Medicare and Medicaid, you won’t pay a monthly premium for Pathways PACE.
• If you don’t qualify for Medicaid, but you have Medicare, you will be charged a monthly premium for Pathways PACE.
• If you don’t have Medicare or Medicaid, you can pay for Pathways PACE privately.

Pathways PACE serves people 55 years of age and older who qualify for nursing home level-of-care according to the State of Colorado guidelines. An assessor must complete a functional assessment with you. The assessor will gather information on your functional status, nutrition risks, physical/mental health, and living arrangements.

Once your functional and financial eligibility is established, Pathways PACE will schedule an assessment at the Day Center. Additional assessments for enrollment may occur in the home. Members of the Pathways PACE Interdisciplinary Team (IDT) will meet with you individually to discuss your needs and goals. IDT members include the primary care provider, registered nurse, social worker, physical therapist, occupational therapist, recreational therapist, dietitian, home care coordinator, personal care attendant, transportation driver, and center director.

Pathways PACE encourages you to include a family member, caregiver, or other representative that will be involved in your current or future care needs at the site visit and home visits. Collaboration of care with you, your IDT, and your caregiver(s) if applicable, is essential to identify your care plan goals. Following the assessment process, the IDT will determine if the program can appropriately meet your needs and if you have met all the eligibility criteria.

The Pathways PACE representative will meet with you and if you wish, your family or caregiver(s), to review and sign the appropriate enrollment materials and answer any questions you may have. During this time, we will discuss:

• Any financial obligation, including any Medicaid client obligation identified by the Colorado Department of Human Services.
• Any other questions or concerns you have regarding the program.
• Coordination of your enrollment date into the Pathways PACE Program. The effective date of your enrollment will be the first day of the month following the date we receive your signed Enrollment Agreement.