Last modified on August 3rd, 2023 at 07:45 pm
Eligibility
We Provide Preventative, Primary, Acute, and Long-term Care Services So That Older Adults Can Continue Living Safely Independently.
PACE (Program of All-Inclusive Care for the Elderly) eligibility is determined by specific PACE enrollment criteria as dictated by the State of Michigan and the Centers for Medicare and Medicaid Services.
Older Adults Are Eligible For This Program If They:
• Are 55 years of age or older
• Live in the service area
• Meet State of Michigan criteria for nursing home level of care
• Can live safely at home with our services
Service Area
Senior CommUnity Care of Michigan provides services to older adults within these Ingham, Eaton, Clinton, Shiawassee, Livingston, and Ionia, County zip codes:
48819, 48821, 48823, 48824, 48825, 48827, 48840, 48842, 48854, 48864, 48872, 48892, 48895, 48906, 48910, 48911, 48912, 48915, 48917, 48924, 48933, 49251, 49264, 49285, 48813, 48837, 48861, 48876, 48890, 49021, 49076, 49096, 49284, 48808, 48820, 48822, 48831, 48835, 48848, 48853, 48866, 48879, 48894, 48851, 48860, 48875
Enrollment Is Easy
Our Enrollment Coordinator will meet with you and a family member or caregiver at your home to explain the program. They will do an assessment of your eligibility and schedule a visit to our Center and a meeting with the doctor, nurses and other key staff. You will receive a medical evaluation and a custom care plan. We complete the enrollment paperwork for you to become a participant. Enrollment is voluntary. You may dis-enroll at any time by notifying your Senior CommUnity Care of Michigan social worker.
Who Pays For This Program?
Senior CommUnity Care of Michigan services are paid for by Medicare, Medicaid or private payment. Once a participant is enrolled, our experts handle the paperwork and claims. Participants must follow the care plan designed by our care team. Participants may be personally liable for the costs of unauthorized or out-of-program services, except for emergency services.
Participant’s Bill of Rights
Your Rights In The Program Of All-Inclusive Care For The Elderly
The Program of All-inclusive Care for the Elderly (PACE) is a special program that combines medical and long-term care services in a community setting. Your PACE program must fully explain your rights to you or someone acting on your behalf in a way you can understand at the time you join.
- You have the right to be treated with respect.
- You have the right to be treated with dignity and respect at all times, to have all of your care kept private, and to get compassionate, considerate care. You have the right:
- To get all of your health care in a safe, clean environment.
- To be free from harm. This includes physical or mental abuse, neglect, physical punishment, being placed by yourself against your will, and any physical or chemical restraint that is used on you for discipline or convenience of staff and that you do not need to treat your medical symptoms or to prevent injury.
- To be encouraged to exercise your rights at VOANS Senior CommUnity Care of Michigan.
- To get help, if you need it, to use the Medicare and Medicaid complaint and appeal processes, and your civil and other legal rights.
- To be encouraged and helped in talking to VOANS Senior CommUnity Care of Michigan staff about changes in policy and services you think should be made.
- To use a telephone while at the VOANS Senior CommUnity Care of Michigan Center.
- To not have to perform work or services for Senior CommUnity Care of Michigan.
- To get all of your health care in a safe, clean environment.
- You have a right to protection against discrimination.
- Discrimination is against the law. Every company or agency that works with Medicare and Medicaid must obey the law. They cannot discriminate against you because of your:
- Race / Ethnic Origin
- Religion
- Age
- Sex
- Mental or physical ability
- Sexual Orientation
- Source of payment for your health care (For example, Medicare or Medicaid)
- If you think you have been discriminated against for any of these reasons, contact a staff member at the PACE program to help you resolve your problem. If you have any questions, you can call the Office for Civil Rights at 1-800-368-1019. TTY users should call 1.800.537.7697.
- You have a right to information and assistance.
- You have the right to get accurate, easy-to-understand information and to have someone help you make informed health care decisions. You have the right:
- To have someone help you if you have a language or communication barrier so you can understand all information given to you.
- To have VOANS Senior CommUnity Care of Michigan interpret the information into your preferred language in a culturally competent manner. If your first language is not English and you cannot speak English well enough to understand the information being given to you.
- To get marketing materials and your PACE rights in English or in any other frequently used language in your community, including Braille, if necessary.
- To get a written copy of your rights from VOANS Senior CommUnity Care of Michigan. These rights must be posted in a public place in the VOANS Senior CommUnity Care of Michigan center where it is accessible to all participants.
- To be fully informed, in writing, of the services offered by VOANS Senior CommUnity Care of Michigan. This includes telling you which services are provided by contractors instead of the VOANS Senior CommUnity Care of Michigan staff. You must be given this information before you join, at the time you join and when you need to make a choice about what services to receive.
- To review the results of the most recent reviews of VOANS Senior CommUnity Care of Michigan. Federal and State agencies review all PACE programs. You also have a right to review how VOANS Senior CommUnity Care of Michigan plans to correct any problems that are found at inspection.
- To contact 1-800-MEDICARE for information and assistance, including to make a complaint related to the quality of care or the delivery of a service.
- You have a right to a choice of providers.
- You have the right to choose a health care provider within VOANS Senior CommUnity Care of Michigan’s network and to get quality health care. Women have the right to get services from a qualified women’s health care specialist for routine or preventive women’s health care services.
- You have a right to access emergency services.
- You have the right to get emergency services when and where you need them without VOANS Senior CommUnity Care of Michigan’s approval. A medical emergency is when you think your health is in serious danger—when every second counts. You may have a bad injury, sudden illness or an illness quickly getting much worse. You can get emergency care anywhere in the United States.
- You have a right to participate in treatment decisions.
- You have the right to fully participate in all decisions related to your health care. If you cannot fully participate in your treatment decisions or you want to have someone you trust help you, you have the right to choose that person to act on your behalf. You have the right:
- To have all treatment options explained to you in a language you understand, to be fully informed of your health status and how well you are doing, and to make health care decisions. This includes the right not to get treatment or take medications. If you choose not to get treatment or take medications, you must be told how this will affect your health.
- To have VOANS Senior CommUnity Care of Michigan help you create an Advance Directive. An Advance Directive is a written document that says how you want medical decisions to be made in case you cannot speak for yourself. You should provide this to the person who will carry out your instructions and make health care decisions for you.
- To participate in making and carrying out your plan of care. You can ask for your plan of care to be reviewed at any time.
- To be given advance notice, in writing, of any plan to move you to another treatment setting and the reason you are being moved.
- You have a right to have your health information kept private.
- You have the right to talk with health care providers in private and to have your personal health care information kept private as protected under State and Federal laws. You also have the right to look at and receive copies of your medical records.
- There is a patient privacy rule that gives you more access to your own medical records and more control over how your personal health information is used. If you have any questions about this privacy rule, call the Office for Civil Rights at 1.800.368.1019.
- TTY users should call 1.800.537.7697.
- You have a right to file a complaint.
- You have a right to complain about the services you receive or that you need and don’t receive, the quality of your care, or any other concerns or problems you have with VOANS Senior CommUnity Care of Michigan. You have the right to a fair and timely process for resolving concerns with VOANS Senior CommUnity Care of Michigan. You have the right:
- To a full explanation of the complaint process.
- To be encouraged and helped to freely explain your complaints to VOANS Senior CommUnity Care of Michigan staff and outside representatives of your choice. You must not be harmed in any way for telling someone your concerns. This includes being punished, threatened, or discriminated against.
- To appeal any treatment decision by VOANS Senior CommUnity Care of Michigan, staff, or contractors.
- You have a right to leave the program.
- If for any reason, you do not feel that VOANS Senior CommUnity Care of Michigan is what you want, you have the right to leave the program at any time.
Grievances and Appeals
Our Participant Grievance and Appeal Process is Outlined Below
I. Grievance Process
A grievance is defined as a written or oral expression of dissatisfaction with service delivery or quality of care furnished. VOANS Senior CommUnity Care of Michigan shares the responsibility for assuring you are satisfied with the care you receive.
We understand that sometimes there are areas of dissatisfaction that require our attention and response. If you are dissatisfied, we encourage you to express any complaints or concerns you may have. If you do not speak English, a staff member, professional, or volunteer who speaks your language will facilitate the grievance process.
You may submit a grievance at any time by simply telling an employee, telephoning the PACE Center at (517.319.0700), or by writing a letter and mailing/faxing it to:
Attention: Compliance Coordinator
VOANS Senior CommUnity Care of Michigan
1921 East Miller Road
Lansing, MI 48911
(Fax No. 517.319.0650)
For all follow up and status inquiries, please reach out to our Quality Coordinator at 517.319.0669
SCCMI will discuss the grievance with you and provide you with written information about the specific steps that will take place to resolve your grievance. You can discuss your concerns or send a letter expressing them to any member of the staff or administration of SCCMI. All services will be continued during the grievance process.
The staff member who receives your grievance will forward it to the SCCMI Quality Assurance Department and see that action is taken. You will receive a written acknowledgment of the grievance within five (5) working days of receiving it.
If a solution is found by the staff and agreed upon by you, your family, or significant other within thirty (30) working days, the grievance will be considered resolved.
If you are not satisfied with the outcome, you may take your grievance to the Executive Director or send it in writing to:
Executive Director
VOANS Senior CommUnity Care of Michigan
1921 East Miller Road
Lansing, MI 48911
This must be done within thirty (30 days) of the final decision of your original grievance.
The SCCMI Executive Director will send a written acknowledgment of receipt of the grievance within five (5) business days to you, your family, or your significant other. The SCCMI Executive Director will then investigate and take action.
The grievance should be resolved within thirty (30) days from the date it was received by the SCCMI Executive Director. Following the resolution of the grievance, a copy of the report will be sent to you or your representative.
II. Appeals Process
An appeal is defined as a participant’s and/or representative action concerning VOANS Senior CommUnity Care of Michigan non-coverage of or non-payment for denials, reductions, or termination of services.
VOANS Senior CommUnity Care of Michigan’s decision to involuntary disenroll a participant may also be appealed.
You have a right to appeal a denial of enrollment and/or treatment decisions made by VOANS Senior CommUnity Care of Michigan or its contracted Providers, including decisions not to authorize or pay for items and services which you believe are covered by VOANS Senior CommUnity Care of Michigan.
You may request an appeal at any time by simply telling an employee, telephoning the PACE Center at (517.319.0700), or by writing a letter and mailing/faxing it to:
Attention: Compliance Coordinator
VOANS Senior CommUnity Care of Michigan
1921 East Miller Road
Lansing, MI 48911
(Fax No. 517.319.0650)
A written description of the appeals process will be reviewed with you or your representative at enrollment, at least annually, and any time the Team denies any request for service or payment. The written information will explain how long it will take to decide on your appeal and what factors will be considered in the decision. You will be assisted to complete an appeal by VOANS Senior CommUnity Care of Michigan if you choose to do so.
VOANS Senior CommUnity Care of Michigan will continue to furnish the disputed services until issuance of the final determination if the following conditions are met:
A. VOANS Senior CommUnity Care of Michigan proposes to terminate or reduce services currently being furnished to the participant;
B. You may request continuation with the understanding that you may be liable for the costs of the contested services if the determination is not made in your favor.
VOANS Senior CommUnity Care of Michigan will continue to furnish you with all other required services during the appeals process. There will be no discrimination by VOANS Senior CommUnity Care of Michigan against you because you or your representative filed an appeal.
Participant requests for appeal will be treated by all VOANS Senior CommUnity Care of Michigan employees in a confidential manner and violations of confidentiality will result in disciplinary action.
How to File an Appeal:
You or someone you name to act for you may file an appeal. You can name a relative, friend, advocate, attorney, doctor, or someone else to act for you.
If you appeal, we will appoint an appropriately credentialed impartial third party who was not involved in the original action and who does not have a stake in the outcome of the appeal to review your appeal.
All appeals will be resolved as expeditiously as is required by the condition of your health, but no later than 30 days from our receipt of your appeal. You will have the opportunity to present additional evidence on your case, in person, as well as in writing.
If the appeal is resolved in your favor, VOANS Senior CommUnity Care of Michigan will provide or pay for the disputed service immediately. You will be notified verbally and in writing of the decision.
If you believe that your life or health will be in immediate danger if you do not receive the service denied, your appeal will be expedited.
If your appeal is expedited, VOANS Senior CommUnity Care of Michigan will respond within 72 hours of receipt of your appeal. If your health condition allows and we can show you that we need more time to review the case, we may take up to 14 days to decide on your expedited appeal.
If the credentialed impartial third party does not find in your favor, you have additional appeal rights through Medicaid or Medicare. If the decision is not made in your favor, SCCMI must notify you, the Center for Medicare and Medicaid Services, and the state Medicaid Agency in writing.
Additional Appeal Rights under Medicaid or Medicare
If you choose, you may file an appeal under Medicare or Medicaid, SCCMI will help you or your representative to file an appeal for either.
The process you choose depends upon whether you are eligible for Medicaid, Medicare, and Medicaid (dually eligible) or Medicare only. If you are enrolled in both Medicaid and Medicare (dually eligible), or Medicaid ONLY, you can appeal at any time during the appeals process using the State of Michigan’s Fair Hearing Process by contacting:
Office of Administrative Hearings (OAH)
Attention: Clerk of Court
NEED MICHIGAN ADDRESS!!
You or your authorized representative must send a written appeal request within 30 days of the date of the adverse notification.
Your appeal must be postmarked or received by OAH within 30 days of the adverse decision.
If you file an appeal before the effective date of this action, services may continue during the appeal process.
However, if the decision by OAH is not in your favor, you may be required to reimburse the VOANS program for the cost of services paid on your behalf during the appeal period.
If you wish to file an appeal, we will assist you with the forms. We will forward the adverse notice you received to OAH along with the DMA Form #2003 “Medicaid Services Recipient Hearing Request Form. If you wish to inquire about the status or progress of the appeal, you may call 517.319.0700 or you may send a fax to 517.319.0650.
If the decision is in your favor, we will provide or pay for the service(s) in question as quickly as your health requires, but no more than 30 days after the decision.
If you are eligible for Medicare only and you choose to appeal, the appeal must be made to the Medicare Independent Review Entity (IRE). We will send your appeal to that agency for you.
If Medicare’s decision is in your favor, we will continue to provide or pay for the service(s) in question as quickly as your health requires, but no more than 30 days after the decision.
If you want to appeal a denial of enrollment or disenrollment, you must appeal to the Michigan Office of Administrative Hearings at the above address.
IF YOU OR SOMEONE YOU KNOW NEEDS TO APPOINT A REPRESENTATIVE TO ASSIST YOU, PLEASE UTILIZE THIS LINK TO ACCESS THE CMS FORM 1696
By clicking the button link above, you are acknowledging that you are leaving SCCMI PACE website.