Referral Triggers
This living situation often signals unmet needs and a strong referral opportunity
What is living alone with limited support?
Minimum age requirement for PACE
What is 55 or older?
Most SE participants fall into this insurance coverage category
What is dually eligible?
Most common objection
What is "I don't want to change my doctor?"
If a participant refuses this core component, they are not a fit
What is willingness to change their PCP?
A recent event that frequently creates urgency for PACE enrollment
What is hospitalization or rehab discharge?
This geographic requirement must be met
What is living in the service area?
If over asset, this planning tool may help achieve eligibility
What is a spend down?
One way PACE addresses isolation and need for daytime supervision
What is ADH?
If safety cannot be maintained in this setting, enrollment cannot proceed
What is the community/home environment?
This caregiver situation is a key emotional trigger for referral
What is caregiver burnout or feeling overwhelmed?
The level of care required for eligibility
What is nursing home level of care?
Medicare eligibility requirement for someone 55 to 64
What is disability?
How PACE addresses needs of someone who identifies as "homebound?"
What is in home support and door through door transportation if needed?
A formal requirement for a non-English speaking prospect at the time of the assessment
What is need for a professional interpreter?
When a senior is struggling with these two areas, referral likelihood increases significantly
What are ADLs and IADLs?
Even if someone meets this criteria, this must also be true for enrollment
What is they must be safe to live in the community with PACE support?
Enrollment option for someone who is not income or asset eligible but has Medicare
What is the Medicare only premium?
Getting to appointments has become too difficult
What is PACE transportation support?
Not deemed "home bound by the intake team?
What is the need to visit the site for appointments?
More than half of participants experience this referral trigger.
What is dementia or cognitive impairment?
Assessment identifies these requirements
What is ADLs, IADLs, and a skilled need?
True or False? There is financial eligibility that must be met to enroll in the PACE program
What is false? There is no financial eligibility required. PACE offers options for Medicare, Medicaid, and Duals.
PACE approach to "poly-pharmacy" issues
What is med-reconciliation as part of the new participant on-boarding process?
Non-acceptance by ERN next step
What is petition to state for denial?