Announcement for PACE Provider Initial Application Approval
April 6, 2023
The Department of Health Care Policy and Financing (HCPF) has approved Denver Hospice’s application to become a provider in the Programs of All-Inclusive Care for the Elderly (PACE) for the Denver Metro area.
As Colorado’s population is growing older and living longer, HCPF’s priority is to ensure the needs of Colorado’s Long-Term Services and Supports (LTSS) members are met by establishing new provider relationships to provide these necessary services to our LTSS members. In 2030, 18.4% are projected to be over 55 and as the population ages, HCPF will need new providers to ensure coverage of LTSS services. With the operation of multiple PACE providers in the Denver metro area, HCPF can assure that our LTSS community needs are met and gives Medicaid members a choice in PACE providers.
The Denver Hospice has been serving Denver since 1978 and currently serves approximately 915 individuals. Under Denver Hospice’s proposal, they plan to serve 81 zip codes which includes Denver County and portions of Jefferson, Arapahoe, Douglas, Broomfield, and Adams counties. Their proposed PACE center will be located at 3015 South Parker Road in Aurora. HCPF’s approval is the initial step in the application process and Denver Hospice must now seek approval through the Centers for Medicare and Medicaid Services (CMS). Upon CMS’ approval, Denver Hospice will return to HCPF for final review and approval. HCPF estimates that Denver Hospice will be operational in two to four years. If you have any questions please contact, HCPF_PACE@state.co.us.
Programs of All-inclusive Care for the Elderly (PACE) provides comprehensive health care services to their participants. One of the main objectives of the PACE program is to enable older adults to live in the community as long as medically and socially feasible.
A PACE organization is responsible for providing care that meets the needs of each participant across all care settings, 24 hours a day, every day of the year. Services must be furnished in at least the PACE center, the home, and inpatient facilities, up to and including admission to an acute care or long-term care facility when the PACE program can no longer support the participant safely in the community. The PACE center includes a primary care clinic and areas for therapeutic recreation, restorative therapies, socialization, personal care, and dining, and serves as the focal point for coordination and provision of most PACE services.
PACE organizations are monitored by the Centers for Medicare and Medicaid Services (CMS) in cooperation with the Department of Health Care Policy and Financing (HCPF). For more information on the PACE program, visit the Code of Federal Regulations, Title 42, Chapter IV, Subchapter E, Part 460.
January 23, 2023
Effective January 23, 2023, the Department of Health Care Policy and Financing (HCPF) will lift the moratorium on new enrollments into InnovAge Colorado’s PACE program. This means Health First Colorado (Colorado’s Medicaid program) members not currently receiving PACE services from InnovAge Colorado can enroll at their choice. The moratorium was put in place in December 2021 following extensive and concerning audit findings surrounding quality-of-care concerns raised by Health First Colorado (Colorado’s Medicaid program) members. HCPF will continue to monitor InnovAge Colorado’s operations to ensure the continued health, safety and welfare of Health First Colorado members.
- InnovAge Notice of Release - January 2023
December 23, 2021
Effective December 23, 2021 the HCPF suspended new enrollments into InnovAge Colorado’s PACE program following numerous regulatory violations and non-compliance with HCPF’s provider contract. The moratorium on new enrollments will remain in effect until InnovAge Colorado completes a Corrective Action Plan to the satisfaction of HCPF and the Centers for Medicare and Medicaid Services.
- InnovAge Notice of Action - December 2021
- Summary of Findings-InnovAge Complaint Investigation - December 2021
- InnovAge Enrollment Moratorium FAQ - December 2021
- InnovAge FAQ for Members - December 2021
- Press Release: Colorado Medicaid Suspends New PACE Enrollments at InnovAge Centers Following Audit Findings - December 2021
To be eligible to enroll in PACE, an individual must meet the following requirements:
- Be 55 years of age or older;
- Meet nursing facility level of care;
- Live in the service area of the PACE organization; and
- Be able to live in a community setting without risking his or her health or safety at the time of enrollment.
Participants may disenroll from the program at any time, for any reason.
Benefits and Services
The PACE benefit package for all participants, regardless of the source of payment, must include the following:
- All Medicare-covered services
- All Medicaid-covered services as specified in the Medicaid State Plan. Note: Colorado’s Medicaid program is called Health First Colorado.
- Other services determined necessary by the interdisciplinary team to improve and maintain the participant’s overall health status
Services include, but are not limited to:
Note: Participants must receive benefits solely through the PACE organization and select providers within the PACE organization’s network. Participants may be fully and personally liable for the costs of unauthorized or out-of-PACE program agreement services.
- Provides a side-by-side comparison of the adult home and community-based services waivers to the benefits of the PACE program
What is the Interdisciplinary Team?
The interdisciplinary team is a group of professionals from various disciplines who are responsible for a participant’s initial assessment, periodic reassessments, plan of care, and coordination of 24-hour care delivery. The team monitors the participant’s plan of care whether the services are furnished by PACE employees or contractors.
A participant has the right to participate fully in all decisions related to his or her treatment, including the right to participate in the development and implementation of the plan of care. Note: A participant who is unable to participate fully in treatment decisions has the right to designate a representative.
The interdisciplinary team must include:
- Primary care physician
- Registered nurse
- Master’s-level social worker
- Physical therapist
- Occupational therapist
- Recreational therapist or activity coordinator
- PACE center supervisor
- Home-care coordinator
- Personal care attendant
- Transportation staff
Complaints and Appeals
Each participant has the right to a fair and efficient process for resolving differences with the PACE organization including the right to:
- Voice a complaint/grievance, either orally or in writing, to the PACE organization and outside representatives if they are not satisfied with a service delivery or the quality of care furnished.
- Appeal any treatment decision of the PACE organization, its employees, or contractors. The PACE organization will assist any participant with filing an appeal to an impartial third party. Participants who are eligible for Medicare, Health First Colorado, or both, also have the right to an external review by either the Independent Review Entity (Medicare) or the State Fair Hearing (Health First Colorado) process.
A participant may also contact the PACE ombudsman to assist with complaints and appeals.
The amount that a PACE organization can charge a participant as a monthly premium depends on the participant's eligibility under Medicare and Health First Colorado. The PACE organization will provide a description of participant premiums, if any, and procedures for payment of premiums during the enrollment process.
- A PACE organization may not charge a premium to a participant who is eligible for both Medicare and Health First Colorado, or who is only eligible for Health First Colorado.
- A PACE organization may charge a premium to a participant who is only eligible for Medicare.
- There is also a private pay option for participants who are not eligible for either Medicare or Health First Colorado.
How to Apply
Contact the PACE organization in your area to apply. The Colorado PACE organizations and the areas they serve are in the table below.
- PACE organizations determine if an applicant meets PACE program eligibility criteria.
- Single Entry Point Agencies determine if an applicant meets the functional criteria for PACE, meaning the applicant meets the nursing facility level of care.
- County Departments of Human Services determine if an applicant meets the financial criteria for Health First Colorado. An applicant may apply in person or online using the Colorado Program Eligibility and Application Kit (PEAK). Note: PACE organizations will often assist applicants with completing the financial application for Health First Colorado but they are not responsible for determining an applicant’s financial eligibility for Health First Colorado.
|PACE Organization||County/Service Area||Phone Number|
|InnovAge Colorado PACE||Adams, Arapahoe, Broomfield, Denver, Jefferson, Larimer, Pueblo, Weld||
Toll Free: 844-948-0792
|Rocky Mountain PACE||El Paso||
Toll Free: 855-207-0702
|Senior CommUnity Care PACE||Delta, Montrose||
Toll Free: 866-961-1451
|TRU PACE||Boulder, Weld (Southwest)||
Toll Free: 844-350-7223
If you would like to discuss your PACE benefits or have additional questions about the PACE program, contact the PACE organization in your area.
If you would like information on other programs, contact your local Single Entry Point Agency, the Health First Colorado Member Contact Center, or visit the Long-Term Services and Supports Programs page.
If you have questions about your health care, please talk with your doctor.
The PACE Ombudsman Program protects the rights of PACE applicants and participants in Colorado. The program offers free, confidential advocacy and assistance with issues like, access to services, denial of services, care coordination, grievances, appeals, and more.