Kentucky New Horizon

Throughout the year, we publish New Horizon, our newsletter for providers with patients with coverage through Humana Healthy Horizons® in Kentucky. We post content from the current issue below and also link to content from previous issues.

The May 2022 edition includes articles about:

  • Behavioral health surveys
  • Monitoring metabolic health in patients with mental health diagnoses
  • Improving medication adherence for your patients with depression
  • Ensuring children and adolescents receive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services
  • How someone’s environment and behavior affects their health
  • Early elective delivery claims documentation procedures
  • Simplifying how you work with Humana Healthy Horizons in Kentucky

Download the current edition of New Horizon , PDF

Behavioral health surveys offer valuable insights to improve outcomes and identify needs

Severe weather and COVID-19 have affected the physical and mental health of many Humana Healthy Horizons® in Kentucky enrollees. Providing care that meets immediate physical needs and long-term emotional needs is more important than ever.

Through ongoing collaborative efforts, we gather patient insights by surveying those who utilize behavioral health services. These surveys include the Mental Health Statistics Improvement Program, Experience of Care and Health Outcomes and Youth Services Survey for Youth and Families. These surveys provide valuable feedback about behavioral healthcare, including outcomes, function, access and social connectedness. Behavioral health providers can help improve patients’ lives by:

  • Conducting routine and ongoing assessments of daily functioning and support systems
  • Evaluating social determinants of health (SDOH) needs, such as housing and transportation
  • Identifying available resources or referring for care management
  • Ensuring collaboration of care with primary care physicians, other healthcare providers, schools and family
  • Developing a crisis plan with identified support systems
  • Providing a 24-hour resource, such as the Humana Healthy Horizons in Kentucky behavioral health crisis line 833-801-7355 (TTY: 711)

Monitor metabolic health in patients with mental health diagnoses to improve overall health outcomes

Individuals with schizophrenia or bipolar disorder who use antipsychotic medication are at an increased risk for metabolic syndrome and cardiovascular disease.

Diabetes and cardiovascular screenings are important for those with schizophrenia or bipolar disorder due to the increased risks associated with antipsychotic medication use, which is linked to:

  • Heightened risk of metabolic syndrome
  • Elevated blood cholesterol levels
  • Higher risk of cardiovascular disease
  • Poor cardiometabolic outcomes in adulthood for children and adolescents

To learn more about the Healthcare Effectiveness and Data Information Set (HEDIS®) measures1 that address metabolic health for patients with a schizophrenia or bipolar disorder, please visit:

Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder – NCQA

Metabolic Monitoring for Children and Adolescents on Antipsychotics – NCQA

Take advantage of resources to help improve medication adherence for patients with depression

Patients diagnosed with schizophrenia often have difficulty with medication adherence, which can increase their risk of relapse. Using antipsychotic medications as prescribed can reduce the risk of relapse or hospitalizations.

Patients diagnosed with major depression should remain on their antidepressant for at least three months to induce remission and at least six months to preserve remission.

To learn more about the HEDIS measures that address medication adherence for patients diagnosed with a bipolar disorder, schizophrenia or major depression diagnosis, please visit:

Adherence to Antipsychotic Medications for Individuals With Schizophrenia – NCQA

Antidepressant Medication Management – NCQA

Ensure children and adolescents receive EPSDT services

EPSDT is a federally mandated program developed for Medicaid recipients from birth through the end of their 21st birth month. All Humana Healthy Horizons in Kentucky enrollees should receive age-recommended EPSDT preventive exams, health screenings and EPSDT special services to address health issues as soon as identified or suspected. EPSDT benefits are available at no cost to Humana Healthy Horizons in Kentucky enrollees.

EPSDT preventive services
The EPSDT program provides comprehensive preventive healthcare services at regular age intervals and at other times when needed. Regular EPSDT preventive visits find issues including physical health, mental health, growth and development early, so additional testing, evaluation or treatment can start right away. Preventive services can include, but are not limited, to:

  • Laboratory tests, developmental screenings and sensory screenings
  • Vision, dental and hearing services
  • Assessment of immunization status and administration of required vaccines
  • Nutritional assessment including Body Mass Index (BMI) and blood pressure
  • Screening for postpartum depression during 1, 2, 5 and 6 months of age well-child visits

EPSDT exam frequency
The Humana Healthy Horizons in Kentucky EPSDT Periodicity Schedule receives updates frequently to reflect current recommendations from the American Academy of Pediatrics (AAP) and Bright Futures. For updates to the schedule, please visit the American Academy of Pediatrics Kentucky Chapter website.

Federal regulations require all children receive a blood test for lead at 12 months, 24 months and between 25 and 72 months for children who have not had a blood lead screening.

EPSDT special services
EPSDT special services include coverage for other medically necessary healthcare, evaluation, diagnostic services, preventive services, rehabilitative services and treatment or other measures not covered under Kentucky Medicaid. Medical necessity is determined on a case-by-case basis, which often requires prior authorization.

Get details about EPSDT, PDF and Medicaid well-child visits, PDF.

Consider patients’ environment and behavior to improve their health

Social determinants of health (SDOH) affect a wide range of health functions, quality of-life outcomes and risks. A patient’s home environment and daily behaviors can often put them at higher risk for health challenges, including obesity ,depression and heart disease. These challenges sometimes result in multiple nonemergent emergency department (ED) visits.2

SDOH include, but are not limited, to:

  • Employment and working conditions
  • Food insecurity
  • Housing quality and instability
  • Income and social status
  • Loneliness and social isolation
  • Physical inactivity
  • Transportation needs

The following resources may help you identify, screen for and address SDOH:

Addressing Patients’ Social Health Needs – ICD-10-CM SDOH Codes Included , PDF

Food Insecurity SDOH Physician Quick Guide , PDF

Loneliness and Social Isolation SDOH Physician Quick Guide , PDF

SDOH Physician Quick Guide , PDF

Transportation SDOH Physician Quick Guide Humana Healthy Horizons in Kentucky provides support for enrollees with SDOH needs , PDF

If you identify an enrollee with SDOH needs, please refer them to our care management team by emailing KYMCDCaseManagement@humana.com or calling 888-285-1121 (TTY: 711)

Updates to our early elective delivery claims documentation procedures

Humana Healthy Horizons in Kentucky recently updated its policy to allow either medical records or completion of a designated form as documentation when submitting early elective delivery claims.

As a reminder, Humana Healthy Horizons in Kentucky requires the completion of specific documentation for the following services:

  • Abortion
  • Early elective delivery
  • Hysterectomy
  • Hospice
  • Sterilization

For more information on this policy, please visit the network notification page. If you have questions, please call Provider Services at 800-444-9137 (TTY: 711), Monday – Friday, 8 a.m. – 6 p.m., Eastern time.

Use Making It Easier presentations to simplify doing business with us

“Making It Easier for Physicians and Other Healthcare Providers” is a series of educational presentations about Humana claims payment policies and processes.

Download the Tools and Resources for Physicians and Other Healthcare Providers Resource Guide , PDF to learn about Humana’s inventory of useful tools and resources, which can simplify your claims-related and other interactions with Humana.

Visit Humana.com/MakingItEasier today, or Availity.com in the Humana Payer Space under the Resources tab. To sign up for new content notifications, look for the STAY CONNECTED widget at Humana.com/MakingItEasier

Kentucky New Horizon Archive

Access previous editions of New Horizon

Previous editions of the Kentucky New Horizon provider newsletter , PDF

1HEDIS Measurement Year 2022, Volume 1. HEDIS measures monitor for metabolic syndrome in mental health patients with a variety of disorders. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

2Kaplan R., Spittel M., David D. (Eds): Population Health: Behavioral and Social Science Insights. AHRQ. Publication No. 15-0002. Rockville, MD: Agency for Healthcare Research and Quality and Office of Behavioral and Social Sciences Research, National Institutes of Health; July 2015.