How Do You Enroll a Parent in PACE in St. Louis, From First Call to First Service?

PACE, the Program of All-Inclusive Care for the Elderly, is not a home-care agency you hire by the hour. It is a program that coordinates medical care, prescriptions, transportation, home support and other approved services for an enrolled participant. The installation is therefore bigger than scheduling a first visit. You are moving responsibility for covered care to one organization.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Start with a blank sheet divided into four boxes: eligibility, coverage, people and start-up. Write the answer to every question below in the proper box. Do not cancel a plan, pharmacy arrangement or standing service while the application is still being reviewed.

Who pays

A person may qualify for PACE if the person is at least 55, lives in the program's service area, meets Missouri's nursing-facility level-of-care standard and can live safely in the community with PACE services. Medicare describes those four conditions on its PACE page, listed through this desk's Sources page.

The service-area test comes first. Give the PACE organization the home address and ask it to confirm eligibility by ZIP code in writing. A St. Louis mailing address alone does not establish that the house is inside a particular program's boundary.

Next, write down every payer attached to your parent: Medicare Part A, Medicare Part B, a Medicare Advantage plan, a Medicare drug plan, MO HealthNet, retiree coverage, private long-term care insurance and VA benefits. Ask the enrollment worker which coverage PACE will replace, which coverage remains separate and who will handle any cancellation or transition notice.

PACE receives Medicare and Medicaid payments for eligible participants. A person who does not have MO HealthNet may owe a premium, and private-pay enrollment may be possible. Medicare says approved PACE services do not carry deductibles, coinsurance or copayments, but that does not tell you what the monthly obligation will be. Send the rate question to the PACE enrollment office. Ask for the exact monthly amount, what it includes, when billing begins and what happens if MO HealthNet eligibility is still pending.

If VA care, employer coverage or retiree coverage is involved, call that payer before signing. Ask what enrollment will change and request the answer in writing. The enrollment representative can explain PACE. Only the other payer can tell you what it will continue to pay.

The papers

Open one folder labeled PACE application. Put copies in it, not the only originals. Begin with the Medicare card, MO HealthNet card if there is one, photo identification, proof of address, current insurance cards, medication list, provider list and any existing care schedule. Ask the enrollment worker for a written document checklist because the financial file depends on the coverage already in place.

Missouri uses a document titled Program of All-Inclusive Care for the Elderly Level of Care Assessment. The state makes that assessment available through Missouri DSS, as identified on the Sources page. Do not guess at the clinical sections. Ask who schedules the assessment, who completes each section and whether records must be obtained from the physician.

The PACE organization also evaluates whether the person can live safely in the community with the services PACE can arrange. That is not a promise that every requested hour or service will be approved. Ask the assessment team to identify the proposed services, where each service will occur and who decides when the plan changes. The physician and PACE clinical team take over on questions about medical necessity or safety.

The controlling signature is the PACE Enrollment Agreement. Medicaid.gov says enrollment is voluntary and that an eligible person who elects PACE signs this agreement. Before signing, locate these items in the document:

1. The participant's legal name and address.
2. The coverage start day.
3. The monthly amount owed, if any.
4. The process for receiving primary care, prescriptions, specialists, urgent care and emergency care.
5. The rules for services outside the PACE network.
6. The complaint and appeal instructions.
7. The voluntary disenrollment procedure.
8. The person authorized to receive notices and discuss the account.

If your parent signs, let your parent sign. If another person will sign, ask the organization what authority it requires and bring the relevant document. Do not assume that being the child, emergency contact, joint account holder or person who pays the bills supplies signing authority. If the organization questions whether a power of attorney or guardianship document is valid, stop there and take that question to a Missouri lawyer.

The runway

First call: confirm the service area and ask for the enrollment worker's name, direct number and document checklist. Ask whether the first meeting is at home, at the PACE center or both.

Screening: provide the basic identity, residence and coverage information. Ask which conditions remain unverified. Keep a short open-items list with one owner beside each item.

Assessments: complete the Missouri level-of-care process and the PACE organization's evaluation. Have the medication bottles, provider contacts and actual weekly care schedule available. Describe what help is currently provided, including unpaid help. Do not convert your observations into a diagnosis.

Proposed service plan: request a walk-through of the first working week. Put the pickup location, center attendance, home visits, medication supply, meal arrangements and after-hours number on one page. If an essential task has no named provider or time window, the setup is not finished.

Coverage handoff: ask who will notify Medicare, MO HealthNet, the current Medicare plan and the pharmacy. Confirm the coverage start day before anyone cancels automatic payments or discards an insurance card. Medicare warns that joining a separate Medicare drug plan while enrolled in PACE causes disenrollment from PACE, so route every drug-plan solicitation or proposed change back to the PACE benefits contact.

Provider handoff: list every physician, specialist, pharmacy and equipment supplier currently used. Mark each one as continuing, replaced or awaiting an answer. Ask how already scheduled appointments will be handled. Do not cancel an appointment until the PACE team tells you what replaces it.

First service: before the first ride or visit, confirm the pickup window, destination, return arrangement, mobility assistance, contact person and what the participant should carry. Keep the PACE card and after-hours instructions together. Ask whom you call if transportation does not arrive or a home service is missed.

First statement: compare it with the Enrollment Agreement. Check the participant name, covered period, monthly obligation and payment instructions. Call the billing office about a mismatch. Do not treat a verbal explanation as a contract amendment. Ask for a corrected statement or written explanation.

Free help

Missouri SHIP provides free Medicare counseling. Use it before enrollment to trace what happens to a Medicare Advantage plan, drug plan or Medigap policy. Take the coverage list and the unsigned Enrollment Agreement to the counseling session. You can reach the appropriate starting points through Local Help With Paying for Care.

For MO HealthNet eligibility or a pending application, call Missouri DSS. Ask separately about financial eligibility and the PACE level-of-care process because they answer different questions. Write down which office owns each unfinished step.

Your Area Agency on Aging can help you identify local benefits counseling and caregiver support while enrollment is pending. The federal Administration for Community Living identifies area agencies as local access points for aging services, as documented on the Sources page.

The finish line is not the signature. It is the first working service plan with no uncovered handoff: the payer is identified, the Enrollment Agreement is in your folder, the old coverage has not been ended too early, and every first-week task has a name and phone number beside it.