Services

iCircle Care Services

For those needing managed long-term care due to chronic illness and/ or disability, iCircle Care provides a range of coordinated health and social services. Some of these services include: care management, nursing home care, adult day health care, personal care, durable medical equipment, personal emergency response, non-emergent transportation, dentistry, optometry, outpatient OT/PT/SP, Audiology, Hearing Aids, Respiratory Therapy, Nutrition, Private Duty Nursing, home delivered or congregate meals, social day care, social and environmental supports, consumer directed personal care assistance.

Enrolling in iCircle Care will not reduce the benefits you receive through Medicare and/or private insurance. Also, if you enroll in iCircle Care, you WILL be able to keep your current primary care physician.

As a member of iCircle Care, you will be entitled to access the following services*:

* Benefits are subject to the NYS DOH contract in force at the time of service.

Adult Day Health Care

Care and services provided in a residential health care facility or approved extension site for members who are functionally impaired, but not homebound. Among the services included: medical, nursing, food and nutrition, social services, rehabilitation therapy, leisure activities, dental and pharmaceutical.

Audiology/Hearing Aids

Audiology services include hearing examination or testing, hearing aid evaluation, conformity evaluation and hearing aid prescription or recommendations if indicated. Products include hearing aids, earmolds, batteries, special fittings and replacement parts.

Care Management

Care Management (CM) helps you access the benefits identified in your care plan and provides referral/coordination of other service benefits. CM helps you obtain medical, social, educational, psychosocial, financial, and other services, even those not covered by iCircle Care.

Consumer-Directed Personal Assistance Services

Services to chronically ill or physically disabled individuals who have a medical need for help from skilled nursing services or with activities of daily living. Services can include any of the services provided by a personal care aide (home attendant), home health aide, or nurse.

Dentistry

Dentistry includes preventive, prophylactic and other dental care, services and supplies, routine exams, preventive care, oral surgery, and dental prosthetic and orthotic appliances.

Durable Medical Equipment (DME)

DME includes medical/surgical supplies, prosthetics, orthotics and orthopedic footwear, enteral and parenteral formula, and hearing aid batteries. Usually they’re not fitted, designed or fashioned for a particular individual.

Home Care

Home Care includes services which are preventive, therapeutic rehabilitative, health guidance and/or supportive in nature, such as nursing, home health aides, nutritional services, social work services, physical and occupational therapy.

Home Delivered or Congregate Meals

Meals provided in support of your plan of care.

Home Health Aide

A Home Health Aide carries out health care tasks under the supervision of a registered nurse or licensed therapist, and may also provide assistance with personal hygiene, housekeeping and other health-related supportive tasks.

Medical Social Services

MSS involves assessing the need for, arranging for and providing aid for social problems related to the maintenance of a patient in the home.

Medical Supplies

Medical/Surgical supplies are items for medical use other than drugs, prosthetic, or orthotic appliances and devices, durable medical equipment or orthopedic footwear which treat a specific medical condition and which are usually consumable, non-reusable, disposable, for a specific purpose and generally have no salvageable value.

Non-Emergent Transportation

Provides for transportation and an attendant, if necessary, essential to obtain necessary medical care and services.

Nursing Home Care

Nursing Home Care is care provided to by a licensed facility.

Nursing Services

Include intermittent, part-time and continuous nursing services, provided by RNs and LPNs, in accordance with an ordering physician’s treatment plan as outlined in the physician’s recommendation.

Nutrition

The assessment of nutritional needs, or the planning for the provision of appropirate foods and drink, or the provision of nutrition education and counseling.

Optometry/Eyeglasses

The services of an optometrist and an ophthalmic dispenser. Includes eyeglasses; medically necessary contact lenses and polycarbonate lenses, artificial eyes (stock or custom made) and low-vision aids.

Orthotics

Orthotic appliances and devices are appliances and devices used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body.

Personal Care

Some or total assistance with such activities as personal hygiene, dressing and feeding, and nutritional and environmental support function tasks.

Personal Emergency Response System (PERS)

PERS is an electronic device that enables certain high-risk patients to secure help in the event of a physical, emotional or environmental emergency.

Physical, Occupational, Speech, and Other Therapies (provided in a non home setting)

Services are provided by a licensed and registered physical therapist or speech-language pathologist for the purpose of maximum reduction of physical or mental disability and restoration of the enrollee to his or her best functional level.

Podiatry

Services by a podiatrist include routine foot care if a physical condition poses a hazard due to the presence of localized illness, injury or symptoms involving the foot, or when they are performed as necessary and integral part of medical care such as the diagnosis and treatment of diabetes, ulcers, and infections.

Private Duty Nursing

Continuous and skilled nursing care provided in a patient’s home, or under certain conditions a Hospital or Nursing Home, by properly licensed registered professional or licensed practical nurses.

Prosthetics

Prosthetic appliances and devices are appliances and devices, which replace any mission part of the body.

Respiratory Therapy

The performance of preventive, maintenance and rehabilitative airway-related procedures, including the application of medical gases, humidity, and aerosols, intermittent positive pressure, continuous artificial ventilation, and administration of drugs through inhalation.

Social and Environmental Supports

These supports include but are not limited to the following: home maintenance tasks, homemaker/chore services, housing improvement, and respite care.

Social Day Care

A structured, comprehensive program which provides functionally impaired individuals with socialization, supervision and monitoring, personal care and nutrition in a protective setting during part of the day (less than 24 hours).

Limitations

Please refer to iCircle Care’s Member Handbook for service limitations.

Service Not Covered

The following are examples of service that are not covered by iCircle Services MLTC: Primary Care Physician Services, Specialty Physician Services, Emergency Transportation, Inpatient Hospital Services, Outpatient Hospital Services, X-Rays, Laboratory Services, Radiology and Radioisotope Services, Rural Health Clinic Services, Chronic Renal Dialysis, Mental Health Services, Alcohol and Substance Abuse Services, Assisted Living Program, OPWDD Services, Family Planning Services, Prescription and Non-Prescription Drugs.