One of the more robust programs to help Colorado’s seniors age in place is also one of the lesser known sources of such support. It is formally called the Program of All-Inclusive Care for the Elderly, or PACE.

The Colorado Department of Health Care Policy and Financing (DHCPF) says PACE “provides comprehensive health care services to their participants,” and “one of the main objectives of the PACE program is to enable older adults to live in the community as long as medically and socially feasible.”

DHCPF goes on to say a PACE program is responsible for providing care “that meets the needs of each participant across all care settings, 24 hours a day, every day of the year.” Services are furnished in the designated PACE center, the home, and inpatient facilities, up to and including admission to an acute care or long-term care facility when the PACE program can no longer support the participant safely in the community. DHCPF notes that each PACE center includes a primary care clinic and areas for therapeutic recreation, restorative therapies, socialization, personal care, and dining, and serves as the focal point for coordination and provision of most PACE services. PACE programs are monitored by the Centers for Medicare and Medicaid Services (CMS) in cooperation with DHCPF.

On the national level, PACE dates back a little over a quarter century, when it formally became part of the Medicare and Medicaid systems. The programs are said to be difficult to launch due to complex, stringent requirements. Colorado has five PACE programs operating. These are 1) HopeWest PACE, serving Mesa County; 2) InnovAge Colorado PACE, serving the counties of Arapahoe, Broomfield, Denver, Larimer, and Pueblo, and parts of Adams, Jefferson and Weld counties; 3) Rocky Mountain PACE, serving El Paso County; 4) Senior CommUnity Care PACE, serving Delta and Montrose counties; and 5) TRU PACE, serving Boulder county and parts of Adams, Jefferson, and Weld counties. A sixth PACE program was approved in the spring of 2023 to serve Denver County and portions of neighboring counties, with Denver Hospice as “sponsor.” The state may add more as Colorado’s older adult population continues to grow. 

About Colorado’s Newest PACE Program

In announcing Denver County being approved for the newest PACE program to be, DHCPF observed that as Colorado’s population is growing older and living longer, the Department priority is to ensure that the needs of Colorado’s Long-Term Services and Supports (LTSS) members are met by establishing new provider relationships to provide necessary services to LTSS members. “In 2030, 18.4% [of Coloradans] are projected to be over 55,” DHCPF stated, “and as the population ages they will need new providers to ensure coverage of LTSS services. With the operation of multiple PACE providers in the Denver metro area, DHCPF can assure that our LTSS community needs are met and gives Medicaid members a choice in PACE providers.”

The Denver Hospice reportedly serves approximately 915 individuals currently. Under its PACE proposal, they plan to serve 81 zip codes, which includes Denver County and portions of Jefferson, Arapahoe, Douglas, Broomfield, and Adams counties. Their proposed PACE center will be located in Aurora. DHCPF’s approval is the initial step in the application process, and Denver Hospice must now seek approval through the Centers for Medicare and Medicaid Services (CMS). Upon CMS’ approval, Denver Hospice will return to DHCPF for final review and approval, and the Department estimates that Denver Hospice PACE will be operational in two to four years.

Locations for PACE in Colorado Matter

The locations of PACE programs is important, because to be eligible to enroll in PACE, an individual must live in the service area of the program, based on zip codes. Among other criteria for enrollment eligibility, a person must be 55 years of age or older. The individual must also meet “nursing facility level of care,” which means having limitations with activities of daily living that would otherwise qualify them for nursing home care. And they must be able to live in a community setting without risking their health or safety at time of enrollment. Participants may disenroll from the program at any time, for any reason.

Key Additional Note: PACE participants must receive benefits solely through the PACE organization and select providers within the PACE organization’s network.  Participants may be fully and personally liable for the costs of unauthorized or out-of-PACE program agreement services. 

For a full listing of PACE programs in Colorado, the zip codes they serve, and contact numbers, visit https://hcpf.colorado.gov/program-all-inclusive-care-elderly and scroll down to “How to Apply.”

Services PACE Provides for Colorado Seniors

PACE’s “comprehensive services” comprises a remarkable array, with an emphasis on wide-ranging health needs. According to DHCPF, for starters the PACE benefit package includes:

  • All Medicare-covered services.
  • All Medicaid-covered services as specified in the Medicaid State Plan (known in our state as Health First Colorado.)
  • Other services determined necessary by the interdisciplinary team to improve and maintain the participant’s overall health status. (See more on interdisciplinary teams below.)

But it doesn’t stop there. Other provided services include the following:

  • Home care services, including meal preparation and nutrition counseling
  • Physical, occupational, and recreational therapy
  • Physician and nursing care, including emergency services if needed
  • Preventative care
  • Durable medical equipment
  • Mental health services
  • Laboratory and X-ray services, if needed
  • Optometry and dental services
  • Adult day services and respite care
  • Hospital or long-term care, if needed
  • Prescription drugs
  • Social services
  • Transportation

For even greater detail about PACE-provided services as listed by the Colorado Gerontological Society, see https://www.senioranswers.org/financial-resources/pace/.

Interdisciplinary Team Monitors and Manages PACE for Coloradans

DHCPF explains that a PACE interdisciplinary team is a group of professionals from various disciplines who are responsible for a participant’s initial assessment, periodic reassessments, plan of care, and coordination of 24-hour care delivery. This team monitors the participant’s plan of care whether the services are furnished by PACE employees or contractors.

“A participant has the right to participate fully in all decisions related to his or her treatment,” DHCPF says, “including the right to participate in the development and implementation of the plan of care.” If a participant is unable to participate fully in treatment decisions, he or she has the right to designate a representative.

The interdisciplinary team must include:

  • Primary care physician
  • Registered nurse
  • Master’s-level social worker
  • Physical therapist
  • Occupational therapist
  • Recreational therapist or activity coordinator
  • Dietitian
  • PACE center supervisor
  • Home-care coordinator
  • Personal care attendant
  • Transportation staff

Who Pays for Colorado’s PACE Services?

A PACE program can charge a monthly premium for its services, based on a participant’s eligibility for other support services according to Medicare and Health First Colorado (Medicaid) guidelines. The individual PACE program will explain participant premiums, if any, and procedures for payment of premiums during the enrollment process. A PACE program may not charge a premium to a participant who is eligible for both Medicare and Health First Colorado, or who is eligible only for Health First Colorado. But PACE is allowed to charge a premium to a participant who is eligible only for Medicare. For those not eligible for either Medicare or Health First Colorado, there may be private pay options available.

How to Apply for PACE in Colorado

Contact the PACE program in your area to apply. Remember you must live in the service area of the program. As mentioned earlier, a full listing of PACE programs in Colorado, the zip codes they serve, and contact numbers can be found at https://hcpf.colorado.gov/program-all-inclusive-care-elderly when you scroll down to “How to Apply.” (There may be some instances where service areas overlap.) Each PACE program will determine if an applicant meets PACE program eligibility criteria, including but not limited to, whether an applicant lives in their service area. Two other sources can be of help in the application steps:

Note that PACE programs will often assist with completing the financial application for Health First Colorado, but they are not responsible for determining an applicant’s financial eligibility for Health First Colorado.

PACE Appeals Processes and Ombudsman Help for Coloradans

DHCPF states that each participant has the right to a fair and efficient process for resolving differences with the PACE program including the right to: 

  1. Voice a complaint/grievance, either orally or in writing, to the program and outside representatives if they are not satisfied with a service delivery or the quality of care furnished.  
  2. Appeal any treatment decision of the PACE program, its employees, or contractors. The PACE program will assist any participant with filing an appeal to an impartial third party. Participants who are eligible for Medicare, Health First Colorado, or both, also have the right to an external review by either the Independent Review Entity (Medicare) or the State Fair Hearing (Health First Colorado) process. 

A participant may also contact the PACE ombudsman to assist with complaints and appeals. “The PACE Ombudsman Program protects the rights of PACE applicants and participants in Colorado,” says DHCPF. The program offers free, confidential advocacy and assistance with issues like access to services, denial of services, care coordination, grievances, appeals, and more. For more information, visit the Colorado Long-Term Care Ombudsman website.