For Participants

At NEMS PACE, we are dedicated to providing you with quality health care services so you may remain as independent as possible. Our staff is committed to treating each and every participant with dignity and respect and ensuring that all participants are involved in planning for their care and treatment.

As a NEMS PACE participant, you have rights that are summarized in our Participant Bill of Rights.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please review the Notice of Privacy Practices carefully.

We share responsibility for your care and satisfaction with the services you receive. Our Grievance Process is designed to enable you or your representative to express any concerns or dissatisfaction you have so that we can address them in a timely and efficient manner.

You also have the right to appeal any decision about our failure to approve, furnish, arrange for, or continue what you believe are covered services, or to pay for services that you believe we are required to pay.

You may appoint a personal or professional Representative to act on your behalf. To initiate appointment of a Representative, please complete the CMS Appointment of Representative Form and follow the instructions.

Enrollment in PACE is voluntary, and participants may disenroll from NEMS PACE for any reason at any time. When a participant elects to disenroll, the following rights and responsibilities take effect:

• Disenrollments are processed as expediently as allowed under Medicare and Medi-Cal
• Until the voluntary disenrollment is effective, the participant must continue to use NEMS PACE services and pay premiums, if applicable
• NEMS PACE will continue to furnish all necessary services until the effective voluntary disenrollment date

If a participant wishes to appoint a personal or professional Representative to act on their behalf, please complete the CMS Appointment of Representative Form and follow the instructions.

When NEMS transitions to the Epic electronic health records system, all NEMS patients will be automatically enrolled in Epic Care Everywhere, a type of health information exchange (HIE). HIEs like Care Everywhere allow health care providers outside of NEMS to access your most recent electronic health record securely and without delay to care for you as a patient. For example, if you go to a specialist that participates in Care Everywhere, your provider will be able to access your most recent electronic health record at the time of your visit, helping your provider make more informed decisions about your care.

All information contained in your electronic health record will be shared through Care Everywhere, including information related to sensitive services, unless we are required to restrict such information. Psychotherapy notes, information related to drug and alcohol abuse, diagnosis or treatment, and information related to sensitive services that NEMS is required to restrict will not be shared without a separate authorization from you.

To learn more about HIE and how your protected health information will be shared through Care Everywhere, please see our Notice of Privacy Practices.

For a list of organizations that currently participate in Care Everywhere, click here.

You may opt out of Care Everywhere at any time (or opt-back in) by filling out a Health Information Exchange Opt-Out Form and mailing to 1033 Clement Street, San Francisco, CA 94133, or contacting the NEMS Health Information Services Department at 415-391-9686.

• Opt-Out Form – English
• Opt-Out Form – English/Chinese