Providers

Family Care Partnership


 The Family Care Partnership (FCP) Program is an integrated health and long term care program for frail elderly and people with disabilities. The Independent Care Health Plan Partnership Program serves eligible individuals in Milwaukee County. The goals of Partnership are to:

  • Improve quality of health care and service delivery while containing costs;
  • Reduce fragmentation and inefficiency in the existing health care delivery system; and
  • Increase the ability of people to live in the community and participate in decisions regarding their own health care and personal health goals.
FCP Provider Reference Manual

Interdisciplinary Team

An Interdisciplinary Team (IDT), composed of the FCP member and, at a minimum, an iCare Care Manager, a Registered Nurse, and a Nurse Practitioner is assigned upon enrollment into the iCare Family Care Partnership Program.  As appropriate, a guardian, caretakers, and/or other professionals may also participate as members of the Team. The IDT conducts a comprehensive assessment of members’ needs, abilities, preferences, and values to develop a Member Centered Plan (MCP).  The IDT will utilize the Resource Allocation Decision-Making (RAD) process developed by the State of Wisconsin to determine cost-effective strategies to make use of available resources and services to meet a particular outcome.  The Nurse Practitioner will request a collaboration agreement with the member’s physician to facilitate communication and care coordination.

Restrictive Measures

Independent Care Health Plan expects contracted providers to use a comprehensive and systematic approach to assess member needs. The MCO and its subcontracted providers shall comply with ss.51.61(1)(i) and 46.90(1)(i) of the Wis. Stats., and s. DHS 94.10 of the Wis. Admin. Code in any use of isolation, seclusion and restrictive measures. When dangerous or challenging behavior is present, behavioral supports must be included as part of the individual service plan. Behavioral supports included in the plan must be the most positive, effective and least intrusive possible for the individual. Any iCare provider using rights restrictions, isolation, seclusion, chemical restraint or physical restraint must have written policies regarding the use of restrictive measures. Prior to using restrictive measures for a member ICare Providers must get approval for all appropriate governmental agencies. iCare providers are required to inform iCare members or legal representatives of their rights, including the right to be free from restrictive measures. Providers must report any suspected violation of these rights to an iCare team member or licensing agency within one working day.

Provider Network

FCP Provider Reference Manual

In order to assure access to services, Independent Care Health Plan has developed a comprehensive network of long-term care service providers.  All interested providers will be considered for iCare network participation and a contractual relationship. Contracted participation in the iCare network does not include a guarantee of utilization or exclusivity. Interested providers are requested to complete and return a Provider Application which can be found on the Join Us page of the Web Site.

Contracted Provider Room Availability

iCare maintains a registry of FCP contracted residential providers for room availability. Help us keep the registry current by completing the form and e-mailing it to the Attention of: Community Resource Specialist-Family Care Partnership icareresidentialopenings@icare-wi.org. Click on the document below and complete the information.
iCare Residential Availability Form

Authorization and Provision of Services

All services must be authorized through the IDT. Prior to delivery of any services to an iCare FCP member, the provider must obtain a Service Authorization from the IDT staff at iCare outlining the specific services and rates of reimbursement.  A written Service Authorization for each service to be provided will be sent to the provider.

The following information is required to consider a Service Authorization request:

  • member name and number
  • description of services to be provided (service must match service description and codes in provider agreement)
  • units and frequency of service
  • dates of service
  • service location

Providers are requested to notify the IDT as soon as possible in an emergency situation. The IDT will work to authorize necessary services.  For emergencies after-hours, please contact iCare at 414-223-4847 to reach the Care Manager on call.

Claims Submission

More Information

All services for payment must match Service Authorization and be submitted on a claim form. Invoices are NOT acceptable for payment.  Send completed claim form to:

BEGINNING March 18, 2014 iCare Family Care Partnership Long Term Care Claims Address
Independent Care Health Plan
P.O. Box 224255
Dallas, TX   75222-4255

iCare LTC Residential Services Claim Form
iCare LTC Professional Services Claim Form

*Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members. A list of these LONG TERM CARE services can be found here.

Drug Coverage Information

More Information

A list of our covered drugs, as well as descriptions of the additional requirements or limits on the coverage can be found within the Comprehensive Formularies below.  Details regarding prior authorization requirements or step therapy criteria are also posted on this page. 

Requesting Prior Authorization or a Formulary Exception

As indicated within the formulary, a Prior Authorization is required on certain medications before they will be covered. Links to the Prior Authorization forms are located below. We have also provided additional details regarding prior authorization requirements and step therapy criteria.

When the medications on our formulary used to treat a specific condition are not appropriate for a patient, you may request coverage of a non-formulary medication. This type of request is called a Formulary Exception. An exception may also be requested to the Step Therapy criteria when first-line agents are not appropriate for your patient. Request an exception to the Quantity Limit restrictions when the allowed quantity is not enough to adequately treat your patient’s condition. The Prior Authorization forms located below may be used for formulary exceptions as well. Supporting medical information must be submitted with any exception request. The requests should be faxed to our Pharmacy Benefits Manager, MedImpact, at 858-790-7100.

Or, you may click here to submit a prior authorization through the web. You will be redirected to MedImpact's website.

Notification:
By clicking the links above, you may be leaving the icare-wi.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the iCare.wi.org website. These external links are not the responsibility of, or under the control of iCare. Independent Care Health Plan disclaims responsibility for the content and privacy policies of the owners/sponsors of the outside websites.

Modified: 2/6/2017

 

 
 
More Forms & Publications

Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.