ICHS PACE is an innovative model of care that helps seniors live independently in their community. The program is open to anyone:

• Age 55 or older
• In need of nursing home level of care as defined by the state of Washington
• Residing in the PACE service area at the time of enrollment
• Able to live safely in the community with PACE services

There are four steps to enrollment that will help us determine if a PACE program is right for you.

1. Call or email an enrollment specialist. They may also contact you upon receiving a referral.
2. Take a tour of our PACE center and complete initial intake forms.
3. A nurse will visit your home to determine if you can live safely while in PACE.
4. If PACE is a good fit for you, we will have you return to the PACE center to sign final enrollment agreements.

Give us a call at 206.531.2194 to speak with an enrollment specialist and learn more.

What you pay depends on your eligibility under Medicare and Medicaid:

• If you are eligible for Medicaid, or dually eligible for Medicare and Medicaid, you won’t pay a monthly premium for PACE. You may be subject to a “cost of care” amount based on your Medicaid eligibility.
• If you don’t qualify for Medicaid, but you have Medicare, you’ll be charged a monthly premium for PACE.
• If you don’t have Medicare or Medicaid, you can pay for PACE privately.

There’s no deductible or copayment for any drug, service, or care approved by your health care team. PACE participants may be fully and personally liable for the costs of unauthorized or out-of-PACE program agreement services.

If for any reason, you do not feel that the PACE program is what you want, you have the right to leave the program at any time. You will be disenrolled from the program effective the first of the month following coordination of insurance benefits.

As a participant of ICHS PACE, you are encouraged to express your concerns, to file an appeal, and to submit a complaint verbally or in writing at any time without fear of reprisal from our staff.

Grievances
A grievance is defined as a written or oral expression of dissatisfaction with medical or non-medical service delivery or the quality of care provided by ICHS PACE, or our contracted providers.

Appeals
An appeal is an action you may take, whether verbal or in writing, to dispute a decision by ICHS PACE regarding the non-coverage of, or non-payment for a service. This includes service request denials, service reductions, or termination of services.

To file or check the status of a grievance or appeal, PACE participants or their designated representative may notify any PACE staff member in person, or submit the request by telephone, mail or fax:

Attn: PACE Center Manager
ICHS PACE at Ron Chew Healthy Aging & Wellness Center
939 Golf Dr S
Seattle, WA 98144
Fax: (206) 838-3057
Phone: (206) 462-7100
TTY for the hearing impaired: 711

If you would like to appoint a person to file a grievance, request a coverage determination, or request an appeal on your behalf, you and the person accepting the appointment must fill out the Appointment of Representative Form 1696 here (or a written equivalent) and submit it with the request. Your prescribing physician or other prescribers may request a coverage determination, redetermination or IRE reconsideration your behalf without having to be an appointed representative.