Program of All Inclusive Care for the Elderly (PACE) 

The PACE program assists with the care of each participant enrolled in the program based on his or her individual needs with the goal of enabling older individuals to remain living in their community.  

How to file a grievance?  

A PACE participant and/or his/her representative, may voice a grievance to PACE organization (PO) staff in person, by telephone or in writing to a PACE center.  

A grievance is defined as a complaint, either oral or written, expressing dissatisfaction with service delivery or the quality of care furnished, regardless of whether remedial action is requested. Grievances may be between participants and the PO or any other entity or individual through which the PO provides services to the participant.  

A grievance may include, but is not limited to: 

• The quality of services a PACE participant receives in the home, at the PACE Center or in an inpatient stay (hospital, rehabilitative facility, skilled nursing facility, intermediate care facility or residential care facility) 
• Waiting times on the phone, in the waiting room or exam room 
• Behavior of any of the care providers or program staff 
• Adequacy of center facilities 
• Quality of the food provided 
• Transportation services; and  
• A violation of a participant's rights 

Note: The PACE Program as administered by DHCS and PO delivering PACE services in specified ZIP codes throughout the state are committed to assuring that PACE participants are satisfied with the service delivery or quality of care they receive. PO must establish grievance processes to address participants' concerns or dissatisfaction about services provided, provision of care, or any aspect of the PACE program. 

How to find your local PACE organization by County:  

Service Area Counties and Zip Codes 

PACE organization Contact Information  

Timeline: Within five days of receipt of a grievance, a PO will acknowledge receipt of the grievance and identify the person or unit which may be contacted about their grievance. POs work on resolving medical and non-medical grievances within thirty (30) calendar days while maintaining confidentiality, in accordance with regulatory and contractual requirements. 

How to file an appeal?  

An appeal may be filed verbally, either in person or by telephone or in writing. The appeal process is available to any participant, his/her representative or treating provider who disputes denial of payment for a service or the denial, deferral or modification of a service by the primary care physician (PCP) or any member of the interdisciplinary team (IDT) who is qualified to make referrals. 

An appeal is defined as a participant's action taken with respect to the POs noncoverage​​ of, or nonpayment for, a service including denials, reductions or termination of services. 

The appeals process may take one of two following forms:  

• A standard appeal means review process for response to, and resolution of, appeals as expeditiously as the participant's health requires, but no later than 30 calendar days after the PO receives an appeal.  
• An expedited appeal occurs when a participant believes that his or her life, health, or ability to regain maximum function would be seriously jeopardized, absent provision of the service in dispute. The PO will respond to the appeal as expeditiously as that participant's health condition requires, but no later than 72 hours after it receives the appeal. The 72-hour timeframe may be extended by up to 14 calendar days for either of the following reasons:  

1. ​The participant requests the extension. 
   
2. ​​The PO justifies to the State Administering Agency the need for additional information and how the delay is in the interest of the participant.​
   

​​What is a State Hearing?