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All
applicants will be informed about the program prior to enrollment by program
staff. All prospective participants
will receive an assessment by the interdisciplinary team, and at least one will
be an in-home assessment to determine clinical eligibility.
The interdisciplinary team will review the assessments and develop a
comprehensive plan of care prior to enrollment.
To
be eligible an individual must meet all of the following criteria:
- Age
55 or older;
- Resident
of Cattaraugus County or
a resident of the following Allegany County townships: Amity, Angelica,
Belfast, Bolivar, Clarksville, Cuba, Genesee, Friendship, New Hudson and
Wirt;
- Eligible
for Medicaid and/or Medicare, or willing and able to pay the portion of the
PACE premium that is not covered by the participant’s insurance;
- Assessed
during the PACE enrollment process and determined to be eligible for nursing
facility level of care;
- In
need of the long term care services of the plan for at least 120 days;
- Able
to live safely in the community with the services of the plan.
All enrollments are voluntary, and all prospective enrollees will sign an
enrollment agreement as the confirmation of intent to enroll.
Total Senior Care, Inc. will process applications for enrollment in the
order in which they are received, and will not discriminate on the basis of
health status.
All
enrollments will be reviewed and approved by the Cattaraugus County Department
of Social Services and must be accepted by the State’s computerized
eligibility system.
For eligible
individuals that are currently receiving services from a facility or from a Home
and Community Based Services Waiver program, a covered individual cannot be in
both fee for service covered services, and Total Senior Care, Inc. The
individual must be discharged from the facility or waiver program prior to
enrolling in Total Senior Care, Inc. Total
Senior Care, Inc. will, as with all other individuals enrolling in the program,
have upon the individual’s written authorization, their medical records
transferred to Total Senior Care, Inc. Further,
as part of the enrollment process, Total Senior Care, Inc. will cooperate with
Cattaraugus County Department of Social Services and New York State Department
of Health to have their Medicaid covered health services transferred to Total
Senior Care, Inc. upon the effective date of enrollment.
In general, the effective date of enrollment will be the first day of the month
following completion of the enrollment process, including all final
verifications and approvals by the government agencies.
Benefit coverage for Medicaid recipients may begin on the first day of
the subsequent month if Medicaid requires additional time to add you to the PACE
program roster. We will confirm your
actual enrollment date by telephone as soon as possible—usually within a few
days before your participation begins. Once
you are a participant, your Care Team will ensure that you get all the services
that are outlined in your plan of care.
All enrollment
activities will be documented by the Interdisciplinary Care Team, and the
referred individual will receive written confirmation of the results of the
enrollment process.
If
you need further information, contact us.
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