The Program of All-inclusive Care for the Elderly, also called PACE, is a special program that combines medical and long-term care services in a community setting. New Horizons PACE is a PACE program.
When you join New Horizons PACE, you have certain rights and protections. New Horizons PACE shall fully explain your rights and all the rules and regulations governing the PACE program, to you or someone acting on your behalf in a way you can understand at the time you join. New Horizons PACE shall protect and provide you with the ability to exercise your rights.
- You have the right to always receive considerate, respectful care from all New Horizons PACE associates and contractors in all circumstances. Each participant has the right not to be discriminated against in the delivery of required PACE services based on race, ethnicity, national origin, religion, sex, age, sexual orientation, mental or physical disability, or source of payment.
You have the right:
- To receive comprehensive health care in a safe and clean environment and in an accessible manner.
- To be treated with dignity and respect, be afforded privacy and confidentiality in all aspects of care, and to be provided humane care.
- Not to be required to perform services for New Horizons PACE.
- To have reasonable access to a telephone.
- To be free from harm, including physical or mental abuse, neglect, corporal punishment, involuntary seclusion, excessive medication, and any physical or chemical restraint imposed for purposes of discipline or convenience and not to treat your medical symptoms or to prevent injury.
- To be encouraged and assisted to exercise your rights as a participant, including Medicare and Medicaid appeals processes as well as civil and other legal rights.
- To be encouraged and assisted to recommend changes in policies and services to New Horizons PACE associates.
- To receive accurate, easily understood information and to receive assistance in making informed health care decisions. Specifically:
- To be fully informed in writing of the services available from New Horizons PACE, including identification of all services that are delivered through contracts, rather than furnished directly by New Horizons PACE at the following times:
- Prior to and upon enrollment in New Horizons PACE program.
- At the time your needs require the disclosure of such information in order to allow you to make an informed choice.
- To have the enrollment agreement, fully explained in a manner that you can understand.
- To examine, or upon reasonable request, to be helped to examine the results of the most recent review of New Horizons PACE conducted by CMS or MO HealthNet Division and any plan of correction in effect.
- To contact 1-800-MEDICARE or 1-800-633-4227 for information and assistance, including to make a complaint related to the quality of care or the delivery of a service.
- To Choose your healthcare provider, within the New Horizons PACE network, that is enough to ensure access to appropriate high-quality healthcare. Specifically, you have the right to:
- Choose your primary healthcare provider and specialist from within New Horizons PACE network.
- Request that a qualified specialist for women’s health services furnish routine or preventive women’s health services.
- Have reasonable and timely access to specialist as indicated by your health condition and consistent with current clinical practice guidelines.
- Receive necessary care in all care settings, up to and including placement in a long-term care facility when New Horizons PACE can no longer provide the services necessary to maintain you safely in the community.
- Disenroll from New Horizons PACE at any time and have such disenrollment be effective the first day of the month following the date New Horizons PACE receives your notice of voluntary disenrollment.
- You have the right to access Emergency Health Care Services when and where you the need arises without prior to authorization by the New Horizons PACE’s interdisciplinary team.
- You have the right to participate fully in all decisions related to your treatment. If you are unable to participant fully in treatment decisions, you have the right to designate a representative. Specifically, you have the right to the following:
- To have all treatment options explained in a culturally competent manner and to make health care decisions, including the right to refuse treatment, and to be informed of the consequences of the decisions.
- To have an associate at New Horizons PACE explain advance directives and to establish them if you desire to do so.
- To be fully informed of your health and functional status by the interdisciplinary team.
- To participate in the development and implementation of your plan of care.
- To request a reassessment by the interdisciplinary team.
- To be given reasonable advance notice, in writing, of any transfer to another treatment setting and the justification for the transfer (that is, due to medical reasons for your welfare, or that of other participants). New Horizons PACE must document the justification in your medical record.
- You have the right to communicate with health care providers in confidence and to have the confidentiality of your individually identifiable health care information protected. You also have the right to review and copy your own medical records and request amendments to those records. Specifically, you have the right to:
- To be assured of confidential treatment of all information contained in the health record, including information contained in an automated data bank.
- To be assured that your written consent will be obtained for the release of information to persons not otherwise authorized under law to receive it.
- To provide written consent that limits the degree of information and the persons to whom information may be given.
- You have the right to a fair and efficient process for resolving differences (grievances) with New Horizons PACE, including a rigorous system for internal review by New Horizons PACE and an independent system of external review. Specifically, you have the right to:
- To be encouraged and assisted to voice complaints (grievances) to New Horizons PACE associates and outside representatives of your choice, free of any restraint, interference, coercion, discrimination, or reprisal by New Horizons PACE associates.
- To appeal any treatment decision of New Horizons PACE, our associates, or contractors through the process of the appeals process.
5035 Manchester Ave.
St. Louis, MO 63110
Hours: M - F | 8am - 4:30pm
Site currently under review by CMS
Last updated June 23, 2022