FAQ’S

Who is a PACE program for?

PACE is for adults 55 and older that are able to live independently in their home but are dealing with chronic conditions and a higher level of coordinated care. Seniors enrolled in PACE benefit from a wide range of healthcare services provided at the PACE Center or in the home, 365 days a year.

How much will it cost?

PACE programs are funded by both Medicare and Medicaid (Medi-Cal) or private payment. In PACE:

  • There are no out of pocket expenses if you have or are eligible for Medicaid (Medi-Cal), or are dually covered or eligible for both Medicare and Medicaid (Medi-Cal)
  • Participants who do not qualify for Medicaid (Medi-Cal) have a monthly premium
  • There are no deductibles or co-pays for any medication or health care services approved by our care team

Who is eligible?

There are no financial eligibility requirements to become a PACE participant. In order to be eligible for this program you must:

  • Be 55 years of age or older
  • Live in the service care area (add service area icon they can click to go to the map of our service area)
  • Be determined to meet nursing home level of care by the California Department of Health Care Services
  • Have the ability to live safely in the community with the support of PACE services

Is preventive care covered?

Preventive care is not only covered it is encouraged. The focus of every PACE organization is to help you live in the community for as long as possible. To meet this goal, PACE programs focus on preventive care as well as address the chronic health care needs of every participant.

What about my personal doctors?

As a participant of a PACE program, you must receive all care services from San Diego PACE. Your primary care provider will be at the PACE clinic and specialty care will be provided by the San Diego PACE network of specialty care providers. If necessary, specialty providers can be added to the provider network if they agree to contract with San Diego PACE. All decisions regarding your care must be deemed necessary and approved by the Interdisciplinary Team (IDT). Medical care is available 24 hours a day, 7 days a week, 365 days a year.

Is transportation provided?

PACE programs provide free transportation to the PACE Center for activities or medical appointments. PACE also offers free transportation to medical and other approved appointments.

What if my health limits my ability to come to the Center; are there in-home services I would receive?

Those who are eligible will receive in-home care services. Home care services are evaluated by the Home Health Team and ultimately, the Interdisciplinary Team (IDT) decides if Home Care services are needed and determines the type of services that will be approved (these services must be deemed medically necessary). Home Care services may include but are not limited to the following:

  • Personal care (bathing, grooming, dressing)
  • Light housekeeping
  • Preparation of meals
  • Laundry

What do I do at the PACE Center?

One of our specially equipped vans will pick you up and take you to the Center. You may get a medical clinic check-up, labs, wound care and other medically necessary services. At the PACE Day Center, you will also receive a hot meal, plus physical and other rehabilitative therapies, depending on your needs, recreational activities and an opportunity for socialization with other participants at the PACE Day Center.

Do I have to attend the PACE Day Center when I enroll in PACE?

Day Center attendance is not required or mandatory to enroll in PACE. Day Center attendance is evaluated by the Home Health Team and ultimately, the Interdisciplinary Team (IDT) decides the need and frequency of day center attendance for each participant.

Can I appoint someone to be my representative?

Yes, you can. Filling out the CMS Form-1696 will set you on your way to having a representative on your behalf. (click on hyperlink for copy of the form)

How do I voice a concern or grievance or ask about appeals?

  • You can verbally discuss your grievance with any staff member
  • You can contact us for more information on grievances and appeals via telephone at 619-205-4585 and speak to our Quality Assurance Coordinator
  • You can send a written notice to:
    San Diego PACE Quality Assurance Coordinator
    3364 Beyer Blvd
    San Ysidro, CA 92173
    Fax: 619-565-2373

How do I disenroll from PACE?

  • You can disenroll from PACE at any time, with a reason or no reason at all
  • If you want to disenroll please contact us directly at 619-205-4585
  • You can send a written notice to:
    San Diego PACE Quality Assurance Coordinator
    3364 Beyer Blvd
    San Ysidro, CA 92173
    Fax: 619-565-2373

San Diego PACE is a Division of San Ysidro Health. San Diego PACE complies with applicable Federal civil rights law and does not discriminate on the basis of race, color, national origin, age, disability or sex.
Services covered are in accordance with the individualized care plan of each participant and must be approved by the San Diego PACE Interdisciplinary Team (IDT).

San Diego PACE receives monthly payments from Medicare and Medi-Cal to cover services for participants. Most participants who have both Medicare and Medi-Cal or Medi-Cal only do not have to pay any additional costs once they enroll in PACE.

Participants must receive all needed healthcare services (excluding emergency services), from San Diego PACE providers. Participants are personally liable for unauthorized and out-of-network service costs.