Walk with SpiriTrust Lutheran® in the fight against Alzheimer’s disease!

SpiriTrust Lutheran® is proud to support this year’s Alzheimer’s Association Walk to End Alzheimer’s as a Select Sponsor for the walks in Gettysburg and York! Add your flower to the fight to end Alzheimer’s by joining the Spirit Striders at John C. Rudy Park in York on Saturday, October 29 and visit our Facebook page for photos from the recently held walk in Gettysburg.

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SpiriTrust Lutheran® LIFE

SpiriTrust Lutheran® LIFE is an all-inclusive, personalized care program for Pennsylvania seniors 55+ who live in Cumberland, Franklin or Perry County and need help with daily care or rehabilitation.

LIFE (Living Independence for the Elderly) is a managed care program developed by The Centers for Medicare and Medicaid (CMS) to provide a comprehensive, all-inclusive package of medical care, adult day services and home care to help participants live at home. Nationally, the program is known as the Program of All-Inclusive Care for the Elderly (PACE); however, in Pennsylvania the program is known as LIFE and is not affiliated with the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) prescription drug program.

LIFE serves individuals regardless of race, age, color, creed, religion, sex, national origin or ancestry, sexual orientation, mental or physical disability or source of payment. CMS funds and provides oversight to this program through a unique agreement with participating providers across the United States. Enrollment in LIFE is voluntary and participants may dis-enroll at any time.

 

This page was last updated September 27, 2022.
Pending CMS/SAA Approval

 

Program Benefits & Services

SpiriTrust Lutheran® LIFE provides professional care to help seniors stay in their homes. Through enrollment in the LIFE program qualified seniors can:

  • Stay independent with the support of the LIFE Interdisciplinary Team
  • Live safely in the community for as long as possible
  • Achieve optimal health with quality, coordinated care

Based on the plan of care, other authorized services may include, but are not limited to:

  • Adult Day Health Services
  • Audiology Services
  • Dental Services
  • Emergency Care
  • End of Life Services
  • Hospital and Nursing Facility Services
  • In-home Supportive Care
  • Lab and X-ray Services
  • Meals
  • Medical and Non-medical Transportation
  • Medical Specialists
  • Optometry Services and Eyeglasses
  • Nursing and Medical Coverage 24/7
  • Nursing Care
  • Personal Care
  • Pharmaceuticals
  • Physical, Speech and Occupational Therapies
  • Primary Medical Care
  • Recreational and Socialization Activities
  • Social Services
  • Specialized Medical Equipment

LIFE participants must receive all needed healthcare services, including primary care and specialist physician services (other than emergency services), from LIFE or an entity authorized by LIFE. Participants may be fully and personally liable for the costs of services not authorized by or outside of the LIFE program agreement.

Program Eligibility

To be eligible for Senior LIFE, you must:

  • Be age 55 or older
  • Live in a zip code served by SpiriTrust Lutheran®
  • Be able to live safely in a community setting
  • Need a nursing home-level of care as determined by the state

 

Service Area

SpiriTrust Lutheran® LIFE serves seniors in the following PA zip codes:

Cumberland County
17001 | 17007 | 17008 | 17011 | 17012 | 17013 | 17015 | 17019 | 17025 | 17027 | 17043 | 17050 | 17053 | 17055
17065 | 17070 | 17072 | 17081 | 17089 | 17090 | 17093 | 17240 | 17241 | 17257 | 17266 | 17307 | 17324 | 17372
Franklin County
17201 | 17202 | 17222 | 17225 | 17235 | 17237 | 17244 | 17246 | 17247 | 17252 | 17254 | 17256 | 17257 | 17268 | 17270 | 17272
Perry County
17006 | 17020 | 17024 | 17037 | 17040 | 17045 | 17047 | 17053 | 17021 | 17031 | 17062 | 17068 | 17069 | 17071 | 17074 | 17090

Program Costs

 What you pay for LIFE depends on your situation:

  • Participants with Medicare and Medicaid do not have to pay any copays or premiums to LIFE.
  • Participants with only Medicaid pay nothing to LIFE.
  • Participants with only Medicare pay a monthly premium to LIFE.
  • Participants without Medicare or Medicaid can pay privately.
  • No deductible or copayment for any drug, service or care approved by your healthcare team.
  • Participants may be fully and personally liable for the costs of unauthorized services or those outside of the LIFE network.

Interdisciplinary Team

LIFE offers an interdisciplinary team approach to care.

The team includes physicians, nurses, therapists and other healthcare professionals, who together with the participant and caregiver, assess the participant’s needs, develop an individual plan of care and coordinate necessary services.

LIFE Centers

Our Locations

Cumberland LIFE Center
(serving Cumberland & Perry Counties)
1920 Good Hope Road
Enola, PA 17025-1235

Directions

 

Franklin LIFE Center
(serving portions of Franklin County, including these zip codes:
17201 | 17202 | 17222 | 17225 | 17235 | 17237 | 17244 | 17246 | 17247 | 17252 | 17254 | 17256 | 17257 | 17268)
840 Fifth Avenue
Chambersburg, PA 17201

Directions

 

Each of our LIFE Centers include areas for medical treatment, rehabilitation services, personal care, dining and recreation. The Centers are open Monday through Friday, excluding holidays. Program participants may attend the LIFE Center all or any of the five days, as determined by their plan of care.

Our specially equipped vans transport participants from their home to the center and back home.

Program Administration

A PACE organization is a non-profit private or public entity that is primarily engaged in providing PACE health care services. To qualify for PACE, organizations must have:

  • A governing board that includes community representation
  • A physical site to provide adult day services
  • A defined service area
  • The ability to provide the complete service package regardless of frequency or duration of services
  • Safeguards against conflict of interest
  • Demonstrated fiscal soundness

Enrollment

A LIFE representative will meet with the potential participant to review and agree about participation in the LIFE program before an Enrollment Agreement is signed. At this meeting the following will be discussed:

  • The plan of care developed by the interdisciplinary team
  • Notification that enrollment in LIFE results in disenrollment from any other Medicare or Medicaid prepayment plan
  • Notification that all Medicare and Medicaid services will be coordinated by the interdisciplinary team once enrolled
  • A copy of the Participants Rights and Grievance procedure

Once the Enrollment Agreement is signed, you will receive the following:

  • A copy of the Enrollment Agreement.
  • A LIFE participant identification card with a unique identifier within Protected Health Information guidelines.
  • Emergency information to be posted in the participant’s home that identifies the individual as a LIFE participant and provides emergency telephone numbers and instructions about emergency service access.

Contact Us

Our Centers are staffed Monday through Friday, 8:00 a.m. – 4:00 p.m.

Cumberland & Perry County Residents: 717.728.5433
Franklin County Residents:
717.264.5433
Toll-Free:
800.840.9081
Hearing Impaired: TTY 711

Disenrollment

Voluntary Disenrollment:

The LIFE social worker will assist you in transitioning your care to the appropriate Medicare and Medicaid Programs. You will need to sign a Disenrollment Form, which will indicate that you will no longer be entitled to services through SpiriTrust Lutheran® LIFE. Your voluntary disenrollment is effective on the first day of the month following the date that SpiriTrust Lutheran LIFE receives your notice of voluntary disenrollment. Until disenrollment is completed, all services provided the LIFE participant must continue to be authorized by the program. The IDT will make appropriate referrals and ensure medical records are made available to new providers in a timely manner.

Involuntary Disenrollment:

  • A participant may be involuntarily disenrolled for any of the following reasons:
  • The participant, after a 30-day grace period, fails to pay or make satisfactory arrangements to pay any premium due the PACE organization.
  • The participant, after a 30-day grace period, fails to pay or make satisfactory arrangements to pay any applicable Medicaid spend down liability or any amount due under the post-eligibility treatment of income process.
  • The participant or the participant’s caregiver engages in disruptive or threatening behavior
  • The participant moves out of the PACE program service area or is out of the service area for more than 30 consecutive days, unless the PACE organization agrees to a longer absence due to extenuating circumstances.
  • The participant is determined to no longer meet the State Medicaid nursing facility level of care requirements and is not deemed eligible.
  • The PACE program agreement with CMS and the State administering agency is not renewed or is terminated.
  • The PACE organization is unable to offer health care services due to the loss of State licenses or contracts with outside providers.

A previously disenrolled participant may be reinstated in LIFE. If the reason for disenrollment is failure to pay the premium and the participant pays the premium before the effective date of disenrollment, the participant will be reinstated in LIFE with no break in coverage.

Grievance and Appeals

Grievance Procedure

  • A grievance is a complaint, either written or verbal expressing dissatisfaction with service delivery or the quality of care furnished. You may file a grievance any time by (1) calling the LIFE Center, (2) speaking to any LIFE team member or (3) submitting a completed grievance form which can be downloaded by clicking on the green button below or asking for a form at one of the LIFE Centers.

Phone Numbers:
Cumberland & Perry County Residents: 717.728.5433
Franklin County Residents: 717.264.5433
Toll-Free: 800.840.9081
Hearing Impaired: TTY 711

Download Grievance Form

  • You will be provided in writing the steps and time frame for response to your grievance.
  • If within 5 days since the grievance was filed, you agree with the outcome, the form will be completed and the grievance will be considered resolved.
  • If you do not agree to the outcome, a written report will be sent to the Executive Director, or if the grievance involves clinical care, to the Medical Director, for final review and action within 5 working days.
  • After this review but within 5 working days, a copy of the written report will be sent to you.
  • If you still do not agree with the outcome, you have 30 days to submit a request in writing for a review by the SpiriTrust Lutheran® LIFE Plan Advisory Committee.
  • The Plan Advisory Committee will send you written acknowledgment of receipt of the grievance within 5 working days. The committee will then investigate, find a solution and take appropriate actions.
  • The committee has 30 working days from the date the grievance is filed with the committee to send you a completed report containing a description of the grievance, the actions taken to resolve the grievance and the basis for such action.
  • If you do not agree with the results of the committee review, a copy of the report will be sent immediately to CMS, PA DHS and the AAA.

Appeal Procedure

  • An appeal is a participant’s action taken with respect to the non-coverage of or non-payment for a service, denial of enrollment, or involuntary disenrollment of the participant from the program.
  • You will be provided with a notice on how to appeal the decision if you do not agree with our outcome.
  • You must request an appeal either orally or in writing within 30 calendar days of our denial of service notice to you. Confirmation of your request for appeal will be provided to you within 24 hours of receipt of the request.
  • We will continue to furnish the disputed service until the final determination is made if we are proposing to terminate or reduce services currently being provided and if you agree that you will be liable for the cost of the disputed services if the appeal is not resolved in your favor.
  • An impartial third party will review your appeal and you will receive reasonable written advance notice of the third party review so that you have the opportunity to present evidence related to the dispute in person and in writing.
  • You will receive a written report of the outcome of the third party review no later than 30 days after your appeal is filed. If the decision is made in your favor, we will provide or pay for the disputed service immediately.
  • If the decision is not in your favor, a copy of the written report review will be forwarded immediately CMS, PA DHS and the AAA. You will also be notified in writing of your additional appeal rights under Medicare or Medical Assistance through the State Fair Hearing Process. We will assist you in choosing which to pursue and forward the appeal to the appropriate entity.
  • If you feel that not receiving the service in dispute would seriously jeopardize your life, health or ability to regain maximum function, you can request an expedited appeal either orally or in writing. In an expedited appeal, you will receive the outcome within 72 hours of receipt of the appeal.

Contact Us

Our Centers are staffed Monday through Friday, 8:00 a.m. – 4:00 p.m. If you would like to contact us, please call one of the numbers below or complete the Contact Us Form.

Cumberland & Perry County Residents: 717.728.5433
Franklin County Residents:
717.264.5433
Toll-Free:
800.840.9081
Hearing Impaired: TTY 711

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