As an iCare member, you have the right to make recommendations regarding the member rights and responsibilities policy. You, your provider or your designated representative also have the right to receive a copy of iCare’s Member Rights and Responsibilities statement.
If you would like to receive a copy of this statement, please fill out the request hard copy request form by clicking here.
iCare provides free aids and services to people with disabilities to communicate effectively with us. We also provide free language services to people whose primary language is not English. If you need these services to communicate with us, contact Customer Service at 1-800-777-4376 (TY: 711) 24 hours a day, 7 days a week. Our office hours are Monday – Friday, 8:30 a.m. – 5:00 p.m.
We must honor your rights as a member of iCare Family Care Partnership.
About When You May Be Billed for Services
It is vital to follow the rules when you access medical care so you are not billed for services. You must get your care from iCare's network doctors, clinics, and hospitals unless you have our approval. The only exception is in severe emergencies.
If you travel outside of Wisconsin and need emergency services, health care providers can treat you and send claims to iCare. You may have co-payments for emergency services provided outside Wisconsin, but the charges for Medicaid covered services will be no more than charges for services in the network. You will have to pay for any servcie you get outside Wisconsin if hte health care provider refuses to submit claims or refuses to accept iCare payment as payment in full.
About Covered and Non-Covered Services
You do not have to pay for covered services other than required copays. The amount of your copay cannot be greater than it would have been in fee-for-service. To help ensure that you are not billed for services, you must see a provider in iCare's network. The only exception is for emergencies, if you are willing to accept financial responsibility and make a written payment plan with your provider, you may ask for noncovered services. Providers may bill you up to their usual and customary charges for noncovered services. If you get a bill for a service you did not agree to, or believe that you should not have been billed, please call 1-800-777-4376.
Your Rights
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You have the right to be included in the care management process of an assessment of your understanding of your rights, such as control of money, freedom of speech, freedom of religion, right to vote, right to privacy, freedom of association, right to possessions, right to employment, right to education, access to healthcare, and right to choose leisure and rest. You also have the right to an assessment on your understanding of executing advance directives and whether you are aware and understand you can choose a guardian, durable power of attorney or activated power of attorney for health care.
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We must provide information in a way that works for you. To get information from us in a way that works for you, please contact your Care Team.
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We must treat you with dignity, respect, and fairness always. You have the right:
- To get compassionate, considerate care from iCare Family Care Partnership staff and providers.
- To get your care in a safe, clean environment.
- To not have to do work or perform services for iCare Family Care Partnership.
- To be encouraged and helped in talking to iCare Family Care Partnership staff about changes in policy that you think should be made or services that you think should be provided.
- To be encouraged to exercise your rights as a member of iCare Family Care Partnership.
- To be free from discrimination. iCare Family Care Partnership must obey laws that protect you from discrimination or unfair treatment. We do not discriminate based on a person’s race, mental or physical disability, religion, gender, gender identity, sexual orientation, health, ethnicity, creed (beliefs), age, national origin, or source of payment.
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. This means you have the right to be free from being restrained or forced to be alone to make you behave in a certain way or to punish you or because someone finds it useful.
- To be free from abuse, neglect, and financial exploitation.
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Abuse can be physical, emotional, financial, or sexual. Abuse can also be if someone gives you a treatment such as medication, or experimental research without your informed consent.
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Neglect is when a caregiver fails to provide care, services, or supervision which creates significant risk of danger to the individual. Self-neglect is when an individual who is responsible for his or her own care fails to obtain adequate care, including food, shelter, clothing, or medical or dental care.
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Financial exploitation can be fraud, enticement or coercion, theft, misconduct by a fiscal agent, identity theft, forgery, or unauthorized use of financial transaction cards including credit, debit, ATM, and similar cards.
What can you do if you are experiencing abuse, neglect, or financial exploitation?
Your Care Team is available to talk with you about issues that you feel may be abuse, neglect, or financial exploitation. They can help you with reporting or securing services for safety. You should always call 911 in an emergency.
If you feel that you or someone you know is a victim of abuse, neglect, or financial exploitation, you can contact Adult Protective Services. Adult Protective Services help protect the safety of seniors and adults- at-risk who have experienced abuse, neglect, or exploitation. They also help when a person is unable to look after his or her own safety due to a health condition or disability.
You may call the following numbers to report incidents of witnessed or suspected abuse.
Call your Care Team at 1-800-777-4376 to consult with you regarding issues that you feel may constitute abuse, neglect, or financial exploitation. They will assist you with coordination of reporting or securing services for safety.
You should always call 911 in an emergency for immediate assistance. The County Health and Human Services Department offers Adult Protective Services which are provided to people with developmental disabilities, degenerative brain disorder, serious and persistent mental illness, or other similar incapacity to keep the individual safe from abuse, neglect, financial exploitation, or misappropriation of property or prevent the individual from experiencing deterioration or from inflicting harm on himself or herself or another person. Below are the ADRC’s in your area.
ADRC of Dane County
1-855-417-6892
ADRC of Kenosha County
1-800-472-8008
ADRC of Milwaukee County
414-289-6874
ADRC of Racine County
1-866-219-1043
ADRC of Eagle County – Sauk County Office
1-877-794-2372
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We must ensure that you get timely access to your covered services. As a member of iCare Family Care Partnership, you have a right to receive services listed in your care plan when you need them. Your Care Team will arrange for your covered services. Your Care Team will also coordinate with your health care providers. Examples of these are doctors, dentists, and podiatrists. Contact your Care Team for assistance in choosing your providers.
As a member of iCare Family Care Partnership, you have the right to choose a primary care provider (PCP) in the provider network and receive the services listed in your care plan when you need them. Call iCare Family Care Partnership to learn which doctors are accepting new patients. If you think that you are not getting your medical care or drugs within a reasonable amount of time, talk to your Care Team.
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We must protect the privacy of your personal health information. If you have questions or concerns about the privacy of your personal health information, please call your Care Team. See Appendix 7 for iCare Family Care Partnership’s Notice of Privacy.
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We must give you access to your medical records. Ask your Care Team if you want a copy of your records. You have the right to ask iCare Family Care Partnership to change or correct your records.
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We must give you information about iCare Family Care Partnership, our network of providers, and available services. Please contact your Care Team if you want this information or go to our web site (www.iCareHealthPlan.org).
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We must support your right to make decisions about your care.
- You have a right to know about all your choices. This means you have the right to be told about all the options that are available, what they cost and whether they are covered by Partnership. You can also suggest other services or supports that you think would meet your needs.
- You have the right to be told about any risks involved in your care.
- You have the right to say “no” to any recommended care or services.
- You have the right to get second medical opinions.
- You have the right to give instructions about what you want done if you are not able to make decisions for yourself. Sometimes people become unable to make health care decisions for themselves due to accidents or serious illness.
- You have the right to say what you want to happen if you are in this situation. You can appoint a guardian, durable power of attorney or activated power of attorney for health care.
- You can develop an “advance directive.” There are several types of advance directives and different names for them. Documents called “living will” and “power of attorney for health care” are examples of advance directives. Contact your Care Team if you want to know more about advance directives.
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You have the right to receive your Partnership services in places that let you be a true part of the community in which you live. This is your right under the federal home and community-based services settings rule. The rule applies to the setting where you live and the settings outside of your home where you receive services during the day. iCare must make sure you receive your Partnership services in places that connect you to your community and support your independence. This means places that support your ability to:
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Live where you want to live.
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Participate in community life.
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Find and participate in work in the same way as other people in your community.
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Control your schedule.
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Access and control your money.
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Decide who to see and when to see them.
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Maintain your privacy.
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You have a right to file a grievance or appeal if you are dissatisfied with your care or services.
Your Responsibilities
Things you need to do as a member of iCare Family Care Partnership are listed below. If you have any questions, please contact your Care Team. We are here to help.
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Become familiar with the services in the Partnership benefit package. This includes understanding what you need to do to get your services. See Chapters 3 and 4 for more information.
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Participate in the initial and ongoing development of your care plan.
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Participate in the Resource Allocation Decision (RAD) process to find the most cost-effective ways to meet your needs and support your outcomes. Members, families, and friends share responsibility for the most cost-effective use of public tax dollars.
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Talk with your Care Team about ways your friends, family or other community and volunteer organizations may help support you or ways in which you can do more for yourself.
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Follow the care plan that you and your Care Team agree to.
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Tell your doctors and other providers that you are in Partnership so they can work with you and your Care Team to be a part of your care plan.
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Be responsible for your actions if you refuse treatment or do not follow the instructions from your Care Team or providers.
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Use the providers that are part of iCare Family Care Partnership unless you and your Care Team decide otherwise.
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Show your Partnership membership card whenever you get medical care or prescription drugs. It is important to show your membership card so that providers know to bill Partnership not you.
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Show your ForwardHealth card whenever you get prescriptions drugs. It is important to show your ForwardHealth card so that providers know who to bill.
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Follow iCare Family Care Partnership’s procedures for getting care after hours.
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Tell us if you move to a new address or change your phone number.
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Let us know of any planned temporary stay or move out of the service area.
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Provide iCare Family Care Partnership with correct information about your health care needs, finances, and preferences and tell us as soon as possible about any changes in your status. This includes signing a “release of information” form when we need other information you do not have easily available.
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Treat your Team, home care staff, and providers with dignity and respect.
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Accept services without regard to the provider’s race, color, national origin, disability, language, religion, age, gender, gender identity, sex, sexual orientation, health, ancestry, marital status, ethnicity, creed (beliefs), or national origin.
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Pay any monthly costs on time, including any cost share or room and board charges you may have. Let your Care Team know as soon as possible if you have problems with your payment.
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Complete an “Annual Renewal” for Medicaid eligibility. The Income Maintenance agency uses the annual renewal to determine your financial eligibility. The renewal is to make sure you still meet all the program requirements. You will be notified by mail the month before your renewal is due. This letter will tell you how to do your renewal. If you do not complete your renewal timely, you will lose your Medicaid and Partnership coverage and there will be a gap or delay in your benefits. Contact your Care Team if you need assistance or have questions about the annual renewal.
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Use your private insurance benefits, when appropriate. If you have any other health insurance coverage, tell iCare Family Care Partnership and the Income Maintenance agency. Let your Care Team know right away if you enroll in Medicare, or Medicare or think you may be eligible for Medicare.
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Take care of any durable medical equipment (DME), such as wheelchairs, and hospital beds provided to you by iCare Family Care Partnership.
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Report fraud or abuse on the part of providers or iCare Family Care Partnership employees.
If you suspect anyone of misuse of public assistance funds, including Partnership, you can call the fraud hotline or file a report online at:
Report Public Assistance Fraud 1-877-865-3432 (toll-free) or visit www.reportfraud.wisconsin.gov
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Do not engage in any fraudulent activity or abuse benefits. This may include:
- Misrepresenting your level of disability
- Misrepresenting income and asset level
- Misrepresenting residency
- Selling medical equipment supplied by iCare Family Care Partnership
- Any fraudulent activity may result in disenrollment from Partnership or possible criminal prosecution.
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Help your Team, doctors and other providers help you by giving them information, asking questions, sharing concerns, and following through on your care.
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Call your Care Team for help if you have questions or concerns.
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Tell us how we are doing. From time to time, we may ask if you want to take part in member interviews, satisfactions surveys, or other quality review activities. Your responses and comments will help us identify our strengths as well as find the areas we need to improve. Please let us know if you would like to know the results of any surveys. We would be happy to share that information with you.