Frequently Asked Questions

San Diego PACE (Program of All-Inclusive Care for the Elderly), is a geriatric-focused health plan specifically tailored to meet the needs of seniors who are living with chronic conditions that require coordinated care and support. San Diego PACE provides all care and services covered by Medicare and Medi-Cal as well as additional services that are medically necessary through an integrated team of geriatric-specialized healthcare professionals.
‍
San Diego PACE complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
‍
San Diego PACE is a Division of San Ysidro Health.

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.

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 within our service area zip codes
• Meet the Level of Care requirements for a skilled nursing facility as certified by the California Department of Health Care Services
• Be able to live at home or a community setting safely with assistance from San Diego PACE

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 copays  for any medication or health care services approved by our care team

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.

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.

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.

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

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.

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.

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.)

• 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
  1601 Precision Park Ln., San Diego, CA 92173
  Fax: (619) 573-6491

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
1601 Precision Park Ln., San Diego, CA 92173
Fax: (619) 573-6491

• A San Diego PACE participant may voluntarily disenroll from the program with or without cause at any time.
• Disenrollment from San Diego PACE is effective on the first day of the month following the date San Diego PACE receives the notice of voluntary disenrollment.
• Participant’s reinstatement in the fee-for-service system must begin on the first day of a month.
• Participants are encouraged to provide as much advance notice as possible for adequate transition and discharge planning which will be provided by the participant’s Social Worker and the PACE Interdisciplinary Team.
• Until enrollment in San Diego PACE is terminated, participants are required to continue to use San Diego PACE provider services and will remain liable for any premiums that may occur.
• San Diego PACE shall continue to provide all approved services until the effective date of disenrollment.
• San Diego PACE will not be liable for non-approved services with the exception of emergency services.