Immanuel Pathways Eastern Nebraska

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Eastern Nebraska
- About
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- Experience
- Eligibility
- Enrollment
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Eligibility for Immanuel Pathways Eastern Nebraska

PACE® was created as a way to provide you, your family, caregivers, and professional healthcare providers the flexibility to meet your healthcare needs and to help you continue living in the community. Participants must meet certain requirements to be eligible.

Eligibility criteria

Enrollment in a PACE® program is voluntary. To enroll, individuals must meet the following criteria:

You are 55 years old or older.
You are certified by the state in which you live as meeting the need for the nursing home level of care.
You are able to live safely in the community with the help of PACE® services at the time you enroll.
You live in the service area serving select zip codes of Douglas, Sarpy, Cass, Dodge, Saunders, and Washington Counties.

Understanding a Nursing Home Level of Care

While nursing home level of care is assessed by each state individually, assessments typically evaluate the following areas to understand your care needs.

Physical Functional Ability

One's ability (or inability) to complete day-to-day activities, called Activities of Daily Living (ADLs), is commonly considered. These are basic activities a person must complete daily to care for oneself. These activities include bathing and personal hygiene, dressing and undressing oneself, using the toilet and cleaning up after oneself, mobility/transferring (walking from one room to another, getting out of bed and into a chair), and eating.

Instrumental Activities of Daily Living (IADLs) may also be considered. These activities do not necessarily need to be done daily but are necessary to live independently. Examples include shopping for groceries and other essentials, meal preparation, housecleaning, laundry, medication management, and paying the bills.

Health Issues/Medical Needs

One's health, or medical needs, are also frequently considered when determining if a senior meets a Nursing Home Level of Care. Examples include needing assistance with injections, catheter care, and intravenous (put into a vein) medications.

Cognitive Impairment

Cognitive (mental) functioning may also be considered when determining if a senior meets a nursing home level of care. This area is particularly relevant for persons who have Alzheimer's disease or related dementia, such as dementia from Parkinson's disease or Lewy body dementia. Seniors with impaired judgment may not be able to make appropriate and/or safe decisions, putting themselves in danger if living independently without supervision and assistance.

Behavioral Problems

Behavioral issues, also commonly seen in persons with dementia, particularly in the mid-late stage of the disease, may also be taken into account when determining if an individual meets a Nursing Home Level of Care. Such behaviors include frequent wandering from the home and becoming lost, impulsiveness, and aggressiveness (physical, sexual, verbal).

Frequently Asked Questions

Answers to common questions about PACE®

Discover the answers to common questions about Immanuel Pathways' PACE® program. Learn about eligibility, financial considerations, flexibility in enrollment, healthcare providers, and the seamless enrollment process guided by our supportive specialists. Your journey to comprehensive senior care begins here.

: The average Immanuel Pathways participant is 76 years old and has multiple complex medical conditions, cognitive and/or functional impairments, and significant health and long-term care needs. Approximately 90 percent are dually eligible for Medicare and Medicaid.

People interested in enrolling in Pathways (Center name) do not need to be enrolled in Medicare or Medicaid; no financial criteria are considered to determine eligibility. However, individuals cannot be enrolled in a Medicare Advantage (Part C) plan or a Medicare prepay. Participants can also privately pay for PACE®.
: There is never a co-pay, deductible, or coverage gap in PACE®, so you can access the care, services, and medications you need. Because Immanuel Pathways provides and is responsible for all of your care, you will be held financially responsible for any care you receive outside the program not approved by the PACE® interdisciplinary team (IDT).
: Participants can dis-enroll at any time.
: Yes, one of our qualified providers specializing in geriatric medicine will become your Primary Care Doctor. In addition to a primary care physician, you will have an interdisciplinary team of care providers, including social workers, nutritionists, physical therapists, and more.
: Our enrollment process takes approximately 4 to 8 weeks. Our knowledgeable and friendly enrollment specialists will guide you every step of the way.
: Instructions on how to appoint a personal representative are available in the linked CMS Appointment of Representative Form (CMS Form-1696).
: You have a right to leave the program. If, for any reason, you do not feel that the PACE© program is what you want, you have the right to leave the program at any time and have such disenrollment be effective the first day of the month following the date Immanuel Pathways receives your notice of voluntary disenrollment.

The rights and responsibilities of participants upon disenrollment can be found here: English version, Spanish version.
: Instructions on how to file a grievance and an appeal by participants, their family members, or representatives are below. The form can be accessed here, English version, Spanish version.

Participants and/or authorized representatives may submit a grievance with any Immanuel Pathways staff member at any time, either in person, via phone or in writing.

Immanuel Pathways Nebraska
Attn: Executive Director
5755 Sorensen Parkway
Omaha, NE 68152
Phone # (402) 991-0330
Fax# (402) 991-0332

Immanuel Pathways Southwest Iowa
Attn: Executive Director
1702 North 16th Street
Council Bluffs, Iowa 51501
Phone # (712) 256-7284
Fax# (712) 256-4695

Immanuel Pathways Central Iowa
Attn: Executive Director
7700 Hickman Road
Windsor Heights, Iowa 50324
Phone # (515) 270-5000
Fax# (515) 270-4551

If participants and/or authorized representatives do not want to work with Immanuel Pathways to resolve the grievance, participants and/or authorized representatives have the right to submit a grievance directly to the State Administrative Agency.

Nebraska:
Appeal in writing by sending a letter or appeals form to:
NE DHHS, Legal Services-Hearing Section
PO Box 94967
Lincoln, NE 68509-4967
Appeal via telephone by calling 402-595-1178

Iowa:
Appeal in person at DHS Appeals Section or local office
Appel in writing using a letter or appeals from via fax to 515-564-4044
Appeal via telephone by calling 515-281-3094