PACE Ombudsman

What is the PACE Ombudsman Program?

ADVOCATE: Colorado PACE Ombudsman Program logoThe PACE Ombudsman Program advocates for PACE Participants residing in their community of choice in Colorado. The State PACE Ombudsman position was created by the Colorado legislature in 2016 with Senate Bill 16-199; a year later House Bill 17-1264 expanded the PACE Ombudsman program, creating local PACE Ombudsmen. PACE Ombudsmen protect the health, safety and welfare of PACE Participants and advocate at the direction of the participant. Currently, the State PACE Ombudsman provides programmatic oversight and leadership, as well as direct and systemic advocacy for all PACE participants outside of the Denver area. Three local PACE Ombudsmen provide direct advocacy to PACE participants in the Denver Area. PACE Ombudsman services are free, confidential, and participant-directed.

What is PACE?

PACE (Program of All-Inclusive Care for the Elderly) offers comprehensive medical care and social services to people who are 55 years and older and who meet the nursing home level of care. The PACE model of care is a capitated service delivery model and health insurance system that aims to assist individuals in maintaining their highest level of independence by providing services in their home or community of choice.

What is the role of the PACE Ombudsman?

The PACE Ombudsman Program provides critical and independent advocacy to help individuals attempting to enroll in PACE, PACE participants, and those who have dis-enrolled in PACE navigate the complex service delivery system within PACE and ensure quality care. PACE Ombudsmen provide assistance to resolve issues related to care, health, safety, and participant rights.

  • Ensure confidentiality of participants requesting advocacy
  • Advocate for the expressed goals of the participant
  • Investigate and resolve individual and systemic concerns
  • Provide education and outreach to participants, community, outside agencies, and PACE organizations
  • Make recommendations to improve services within the PACE program

Who can contact the PACE Ombudsman?

  • PACE participants
  • Anyone interested in enrolling in a PACE program
  • PACE participants who involuntarily or voluntarily dis-enroll
  • Family members
  • Community professionals
  • Employees of a PACE program

Reasons why people contact the PACE Ombudsman Program

  • Care coordination issues – Gaps in communication and difficulty with the timeliness of services.
  • Benefits and access issues – Continuity of care and access to a choice of services within the PACE network.
  • Appeals and grievances issues – Participants lack information regarding their appeal and grievance rights.
  • Response to service delivery requests – Assist participants in requesting an increase in services or different services to ensure the best possible care.

Participant rights

PACE participants have certain rights and protections. PACE organizations are required to have a written participant Bill of Rights designated to protect and promote the rights of each participant. The PACE program must fully explain your rights to you at the time of your enrollment.

  1. You have the right to be treated with dignity and respect at all times.
  2. You have a right to protection against discrimination.
  3. You have the right to information and assistance.
  4. You have the right to a choice of providers.
  5. You have a right to access emergency services.
  6. You have a right to participate in treatment decisions.
  7. You have a right to have your health information kept private.
  8. You have a right to file a complaint.
  9. You have a right to leave the program.

To view CMS (Center for Medicare and Medicaid) detailed information regarding PACE participant rights, download this document: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pace111c05.pdf

State PACE Ombudsman

Vacant


cdhs_ltcombudsman@state.co.us

 

Find a PACE Ombudsman in your area.