Long-Term Care services

We provide long-term support and services to help you live in your home and your community. Our goal is to help you live where you want for as long as you want.

Our members with LTC coverage get to work with a care coach who will:

• Contact your doctor(s) so you can begin your services
• Help you choose the doctor(s) to see
• Work with you, your family, your caregivers, your doctor(s), and other healthcare providers to make sure that your services work with your medical care and other parts of your life

If you have LTC coverage, a care coach will call you a few days after you are enrolled in our Long-Term Care plan.

If you have questions before you speak with your care coach, call Customer Care at 888-998-7732 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Eastern time.

For a full list of services and to learn what is covered, see your Member Handbook.

Covered LTC services include:

Assistive care

• Adult companion care and attendant nursing care
• Adult day healthcare
• Assistive care services, assisted living, nursing facility services, hospice services, and respite care
• Behavioral management
• Caregiver training
• Care coordination/case management
• Homemaker services
• Intermittent and skilled nursing

Health and wellness services

• Hospice
• Nutritional assessment and risk reduction
• Personal care services
• Personal emergency response system (PERS)
• Physical therapy, respiratory therapy, occupational therapy, and speech therapy

Supplies and other services

• Home accessibility/adaptation services
• Home delivered meals
• Medical equipment and supplies
• Medication administration and management
• Transportation

Plus more from Humana

Humana wants to help you get the most out of your LTC plan by providing extra services and support, including:

• Assisted living bed holds or reservations Cell phone service, PDF opens in new window
• Day trip meal reimbursement/allowance
• Hearing services
• Individual therapy sessions to caregivers
• Non-emergency transportation
• Outpatient hospital services (no monetary limit on services)
• Over-the-counter (OTC) drug allowance (English, PDF opens in new window and Spanish, PDF opens in new window)
• Support to transition out of a nursing facility
• Vaccines
• Vision services

You may need to get approval (also known as prior authorization) before using these benefits. You always can call Customer Care if you have questions about what needs prior authorization.

Care coordination and case management

We know keeping everything organized can be a challenge when it comes to your healthcare. Part of your LTC plan is having the help of a care coach. Your care coach:

• Acts as a care manager while helping you meet your LTC needs
• Is your contact for getting services through our LTC program
• Will help coordinate your care
• Will help manage and organize your care

Learn more about care coordination

Electronic Visit Verification

Humana has partnered with HHAeXchange, a leading Electronic Visit Verification (EVV) vendor, to electronically confirm members are receiving the care they need, when they need it.

Why EVV?

In 2016, the 21st Century CURES Act was passed. This Act requires the individual receiving services and the caregiver performing services to electronically verify the type of service, the date, the location where the service was performed, and the time the service starts and ends.

What is EVV?

EVV is a technology solution that electronically verifies your caregiver or home health aide was providing services in your home on the dates and times scheduled by the agency. This helps ensure your Medicaid dollars are being spent properly on services that were actually delivered to you.

How EVV Works

The process is simple! Your caregiver can electronically clock-in and clock-out at the start and end of each visit and enter the services they performed. This data is automatically sent to the caregiver’s agency for confirmation, and then transferred to Humana for processing.

What to Expect

You may notice your caregiver utilizing HHAeXchange’s EVV methods to clock-in at the start of services and clock-out at the end of services. HHAeXchange offers two simple and easy-to-use methods:

1. Member’s Landline: Using your landline phone, your caregiver can call a special HHAeXchange phone number to clock-in and out and record the services they provided during the visit. The EVV system recognizes the phone call is coming from your home phone, ensuring the caregiver was in the correct location at the time of service.
2. Caregiver Smartphone: Your caregiver can download the HHAeXchange mobile app on their cell phone and clock-in and out while in your home using the mobile app. Their phone’s GPS will verify the location of the service.

If you have any questions or concerns, please contact your homecare agency to discuss which EVV method is best for you.

Participant Direction Option

There is another option for you as a part of your LTC plan—the Participant Direction Option (PDO). The PDO allows you to self-direct your services. You get to choose who provides your services and how and when your services are provided. You are responsible for hiring, training and supervising your direct service workers.

Find more information about PDO

PDO vendor information—GT Independence

• Agency for Health Care Administration (AHCA) PDO Consent Form - English, PDF
• Agency for Health Care Administration (AHCA) PDO Consent Form - Spanish, PDF
• Agency for Health Care Administration (AHCA) PDO Guidelines - English, PDF
• Agency for Health Care Administration (AHCA) PDO Guidelines - Spanish, PDF
• Agency for Health Care Administration (AHCA) PDO Pre-Screening Tool - English, PDF
• Agency for Health Care Administration (AHCA) PDO Pre-Screening Tool - Spanish, PDF
• Agency for Health Care Administration (AHCA) PDO Representative Agreement - English , PDF
• Agency for Health Care Administration (AHCA) PDO Representative Agreement - Spanish, PDF

Continuity of Care

When new health and dental plans are added to your Medicaid benefits, Continuity of Care (CoC) guidelines, PDF opens in new window are in place to make sure you are covered during the transition to these new plans.

COC makes sure that your dental and health services won’t be interrupted when we switch plans. You will be able to see your doctors and fill your prescriptions like normal.

Find a doctor

It is important to know which doctors, specialists, and services you can see on your plan, such as adult day care centers, adult family-care homes, assisted living facilities, home health agencies, homemaker and companion services, hospices, and nursing homes.

Find a doctor with your care manager

Finding a doctor or specialist you trust is important. Your care manager will help you choose a doctor in our LTC network in your area. Talk to your care manager if you need help or have questions.

Find a doctor online

Use our Find a Doctor service to search for a doctor or healthcare facility, compare doctors, filter by distance, and view ratings.

Caregiver tools

Caring for a loved one can be challenging. Humana offers support and resources to help you. Looking for the forms you need to grant a caregiver access? You can find those here, too.

Get caregiver support

LTC Advisory Committee

We value feedback from our members. From time to time, we ask members to share feedback on their experience with their health plan.

We’re looking for members in our Humana Long-Term Care (LTC) Plan to:

• Join our Enrollee Advisory Committee
• Participate in virtual discussions with other members and caregivers
• Share your experience with us (including what you like about your plan and your care managers, would like us to improve, want us to provide you going forward, etc.)

To learn more, you can reach us:

• By phone: 813-392-5303, Monday – Friday, 8 a.m. – 5 p.m.
• By email: Here4U@humana.com