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Member Rights
1. To participate in planning and evaluating your services, including:
• Planning and evaluating your own treatment and services
• Choosing any other individuals you want to participate in planning your services
• Having service plan decisions arrived at using objective criteria
2. To choose to enroll in NorthernBridges, if eligible, and to disenroll from the NorthernBridges Family Care program at any time for any reason.
3. To be free from unlawful discrimination in applying for or receiving the Family Care benefit.
4. To receive prompt eligibility, entitlement, and cost-sharing decisions and assistance.
5. To receive information regarding all services and supports potentially available to a member through the Family Care benefit.
6. To choose services and providers, including:
• For “critical personal services,” to choose any qualified provider who will accept a rate NorthernBridges is willing to pay and meets other NorthernBridges’ requirements and standards. “Critical personal services” are services that involve intimate personal needs involving personal care, home health, private-duty nursing or supportive home care and a provider who is in your home frequently.
• For other services, to choose from the providers within the NorthernBridges network, and to request consideration for providers to be added to the network.
• To have a family member, relative, or friend paid to provide a service approved by the Team if the family member, relative, or friend accepts the rate.
• To choose providers outside the NorthernBridges’ network if the network does not have providers with the specialized knowledge needed to treat your condition or meet your specific needs.
7. To receive the services identified in the individualized service plan, including:
• An objective, individualized assessment to determine your needs and help you identify your own long-term care needs and personal goals or outcomes.
• A service plan tailored to meet your unique needs, circumstances, and preferences as determined by the assessment.
• Services and supports from qualified providers that are prompt, adequate and appropriate for meeting your individual needs and, as much as possible, preserve your health, safety and well being, and keep you free from abuse and neglect.
8. To accuracy and privacy of any information NorthernBridges may have about you. You also have the right to access this information upon request. NorthernBridges must follow the Health Insurance Privacy and Accountability Act (HIPAA) to assure your health information remains confidential.
9. To personal autonomy and other civil and legal rights, including being able to:
• Make your own choices and decisions to the extent that you are able, and to be supported in decision-making in a manner that maximizes your ability and autonomy.
• Manage and control your own services to the extent you are willing and able.
• Receive treatments/services in the least restrictive conditions consistent with your service plan.
• Live in the setting you choose unless there are essential health or long-term support needs that cannot reasonably be met in such a setting, or the preferred setting includes a package of services that exceeds your identified needs.
• Develop an advance directive, such as a durable power of attorney for health care or a living will.
• Fully exercise your rights as a NorthernBridges’ member and any other civil and legal rights to which you are entitled.
• Identify, eliminate or monitor and manage situations where a conflict of interest may exist due to a person or entity having an interest in, or the potential to benefit from, a particular decision, outcome or expenditure.
10. To dignity, respect, fair and equitable treatment, and to be free from discrimination.
11. To request and obtain information on the results of member surveys, contact the Quality Manager for NorthernBridges at (715) 934-2266, toll free (866) 306-6499, or TTY (715) ___-____. 1-800-947-3529.
12. To receive services from culturally competent providers and to information about the specific capacities of providers, such as languages spoken by staff, or adherence to a particular set of religious customs.
13. To request a private room in residential services and to have the procedures explained regarding the authorization of private rooms and the procedure if a private room is not immediately available.
14. To assistance and support in understanding your rights and resolving complaints, grievances, and appeals, including assistance from:
• Your Team and other service providers.
• The NorthernBridges’ Member Advocate at (715) 934-2266, toll free (866) 306-6499, TTY 1-800-947-3529, or email at madvocate@northernbridges.net.
• An external advocate not associated with NorthernBridges or its providers such as a Disability Benefits Specialist or Elderly Benefit Specialist.
15. To use all available rights and grievance and appeal processes beyond those specified in the Family Care benefit such as your rights as a resident of a nursing home or a community-based residential facility.
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