Pacific Northwest PACE Partners

No, there is no cost to you to participate in PACE. However, to receive our services and to avoid any charges, your services must be approved by our care team.

The PACE Program provides more comprehensive services, from traditional medical appointments and nursing care to physical therapy, medication management and light housekeeping. It’s designed to keep you as healthy and independent as possible in your own home and community setting.

PNW PACE Partners is dedicated to providing you with quality health care services so you may remain as independent as possible. If, for any reason, you do not feel that PNW PACE Partners is what you want, you have the right to leave the program at any time. PNW PACE Partners will assist you to return to the services you were receiving before you joined the program.

We encourage you to speak with us anytime about any questions or concerns regarding your care.

We also have a formal grievance process and you have the right to file a grievance about anything, including:

• Quality of services you receive in the home, at the PNW PACE Partners Center, or in any inpatient or housing facility (hospital, nursing facility, or assisted living facility).
• Mistakes you feel have been made by PNW PACE Partners.
• Waiting times on the phone or in the waiting/exam room.
• Behavior of any of your care providers or program staff.
• Adequacy of the PNW PACE Partners Center facility.
• Quality of food provided by PNW PACE Partners.
• Transportation provided by PNW PACE Partners.

You may file a grievance with any PNW PACE Partners staff member at any time, either verbally or in writing. If you have a grievance after hours, you may telephone the on-call administrator at 1-253-459-7270. Our goal is to resolve participant grievances within one day; however, it may take longer. If we need more time to investigate your concerns, we will let you know how long we think it may take. It is the responsibility of our center manager to investigate and seek a resolution of the grievance as soon as possible but no later than 45 calendar days from receipt of all necessary information and no more than 60 days from the date the grievance is received by PNW PACE Partners.The grievance and the resolution to the grievance will be discussed with you, and a final decision will be sent to you in writing. If you do not agree with the grievance decision, you have a right to file an appeal. This will be included in the letter and PNW PACE Partners staff can assist you with this process.

During the grievance process, we will continue to furnish you with PNW PACE Partners services at the frequency provided in your current plan of care. You have the right to voice a grievance without any fear of reprisal, interference, coercion, or discrimination by PNW PACE Partners staff. You can be assured your grievance will be confidentially handled. PNW PACE Partners will not take your services away because you file a grievance.

If Pacific Northwest PACE refuses to provide or pay for a service that you feel is necessary for your health, you or your representative have the right to request an appeal of Pacific Northwest PACE’s decision.

Additionally, if the Pacific Northwest PACE interdisciplinary team denies a request for services or payment or reduces your services, you will be provided with written information about the denial and about how to file an appeal.

You may request an appeal if Pacific Northwest PACE:

• Denies a service: refuses to provide a service you have requested.
• Reduces a service: reduces a previously approved service you are presently receiving.
• Denies payment for a service: refuses to pay for a service you have already received.
• Does not act promptly: fails to respond in the required time to a request for services or payment.

There are two types of appeal systems available to you:

• Pacific Northwest PACE internal appeal process; and,
• External Medicare or Medicaid appeals process.

During the appeal process, we will continue to furnish you with Pacific Northwest PACE services at the frequency provided in your current plan of care. You have the right to make an appeal without any fear of reprisal, interference, coercion, or discrimination by Pacific Northwest PACE staff. You can be assured your appeal will be confidentially handled. Pacific Northwest PACE will not take your services away because you file an appeal.

You may choose to appoint a representative using this form (Note: clicking this link will take you to a different website).

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