Your Humana care coordinator can help you:

• Get the services and support you need to help meet your goals
• Understand your MLTSS benefits and covered services
• Coordinate care with your providers and support system
• Find resources that support your health, safety, and independence
• Address questions or concerns about your care

Your care coordinator may work with you, your caregivers, your providers, and other members of your care team. Together, they can help review your needs, connect you with services, and support your care plan.

Care coordination is available to eligible members at no additional cost. You may choose whether to participate in care coordination services, when applicable.

Humana does not determine eligibility for waiver or nursing home programs. Eligibility is determined by the appropriate State of Illinois agency.

As part of MLTSS, you may have choices about where and how you receive covered services, depending on your eligibility, needs, and program requirements.

You may have the right to choose:

• Whether to receive certain services
• Which qualified provider or agency provides your waiver services
• Whether you receive services at home, in the community, or in another approved setting, when applicable

Your care coordinator can help explain your options.

Humana supports your right to choose qualified providers for covered waiver services, subject to network availability and program requirements.

Your care coordinator can help you find available providers, understand which providers are in the Humana network, and discuss your options if you want to use a provider who is not currently in network.

MLTSS covers certain long-term care services for eligible members who need ongoing care in approved settings. These services may support members in skilled nursing, intermediate care, supportive living, dementia care, state-operated psychiatric facility settings, or other qualifying long-term care settings.

Covered long-term care services include:

• Long-Term Care — Skilled
• Long-Term Care — Intermediate
• Long-Term Care — Mental Illness Recipient Age 22–64
• State-Operated Psychiatric Facility — Mental Illness Recipient Over Age 64
• State-Operated Psychiatric Facility — Mental Illness Recipient Under Age 22
• State-Operated Psychiatric Facility — Mental Illness Recipient Non-Matchable
• Long-Term Care — Recipient Age 22–64 in Institution for Mental Disease
• Long-Term Care — Supportive Living Program Dementia Care
• Long-Term Care — Supportive Living Facility Waivers

MLTSS may cover services that help eligible members receive care and support at home or in the community. These services are intended to help members with daily living needs, caregiver relief, supervision, habilitation, and safety-related support when program requirements are met.

Covered home- and community-based support include:

• Homemaker
• Agency Providers — RN, LPN, CNA, and Therapies
• Individual Providers — PA, RN, LPN, CNA, and Therapies
• Adult Day Health
• Habilitation Services
• Respite Care
• Other HCFA-Approved Services
• Electronic Home Response/EHR Installation, MPE Certification, Automated Medication Dispenser

MLTSS includes certain behavioral health and substance use services that support eligible members’ mental health, recovery, counseling, rehabilitation, and care coordination needs. These services may be covered when provided according to applicable program rules and requirements.

Covered behavioral health and substance use services include:

• Mental Health Rehab Option Services
• Alcohol and Substance Abuse Rehabilitation Services
• Targeted Case Management Service — Mental Health
• Social Work Service
• Psychologist Service
• Other Behavioral Health Services
• Licensed Clinical Professional Counselor

Transportation may be covered when needed to help eligible members access covered healthcare services. Coverage and payment responsibility may vary by transportation type. Some services, including non-emergency ambulance transportation, may be paid directly by HFS.

Covered transportation services include:

• Non-Emergency Ambulance Transportation[AH1.1]
• Medicare Transportation
• Taxicab Services
• Service Car
• Auto Transportation — Private
• Other Transportation