The following training modules must be completed annually by healthcare providers who participate in Humana Medicare Advantage (MA) Special Needs Plans (SNPs); Humana Healthy Horizons® Medicaid plans in one or more applicable states; and/or a Humana Medicare-Medicaid dual plan in Illinois. Read below to determine which modules apply to your practice.
For providers serving Humana MA SNPs, including chronic SNPs (C-SNPs), dual-eligible SNPs (D-SNPs), institutional SNPs (I-SNPs) and institutional-equivalent SNPs (IE-SNPs)
Healthcare providers serving any Humana Medicare SNP members in the following states/territories are required to comply with SNP training:
Healthcare providers serving any Humana Medicare SNP members in the following states/territories are required to comply with SNP training:
Providers, including noncontracted providers, can access the training here:
Humana 2022 SNP Provider Training (English) - Once this module is completed in its entirety you will receive a Certificate of Completion that serves as your attestation.
Humana 2022 SNP Provider Training (Spanish-Puerto Rico), PDF
The training and attestation also is available through
For providers serving Humana Healthy Horizons® plans in Florida, Kentucky, Ohio and/or South Carolina or Humana’s duals plan in Illinois
If you are contracted to provide services for a Medicaid plan administered by Humana Healthy Horizons in Florida, Kentucky, Louisiana, Ohio and/or South Carolina or a Humana duals plan in Illinois, you are required to take the modules below. Your training may include any or all of the modules, depending on the state(s) in which you are contracted.
- 2023 Humana Healthy Horizons Provider Orientation Training
- 2022 Humana Healthy Horizons Provider Orientation Training
- 2022 Humana Dual-Eligibles Orientation Training
- 2022 Dual-Eligible Medicaid Provider Training
- Abuse, Neglect, and Exploitation (ANE) Training
- Florida, Illinois, Kentucky, Louisiana, Ohio, and/or South Carolina
00:00:00:10 - 00:00:27:25
Unknown
Welcome to the abuse, neglect and exploitation training. As you can imagine, abuse, neglect and exploitation is an extremely important topic for all of us working in Medicaid to be knowledgeable about. Within each of our roles, we should understand each a new term and understand the impact that abuse, neglect and exploitation can have on the vulnerable populations we serve and know what the signs and symptoms to look for.
00:00:28:21 - 00:00:54:00
Unknown
We will go through each of these in this training module as well as some scenarios for you to then test out your skills. Ending with additional resources. Abuse of a vulnerable population is a prevalent problem that often affects the victim as well as those around them. According to the National Council on Aging, up to 5 million older adults experienced some form of abuse, neglect or exploitation.
00:00:54:00 - 00:01:27:09
Unknown
In America every year. That abuse could occur in any location, including at home, at a facility or while out in the community. 60% of abusers are often family members. But what can we do? We can be knowledgeable about all the forms abuse can take, look out for signs of abuse and offer resources and help. Further statistics show that on average, one in ten individuals over the age of 60 have experienced a form of abuse and only a small percentage of which are then reported to the authorities.
00:01:28:09 - 00:02:00:27
Unknown
A vulnerable population includes those individuals that are in a racial or ethnic minority group children, elderly, socioeconomically disadvantaged, under-insured and uninsured, and those with certain medical conditions. This is not a comprehensive list, as there are many factors that contribute to an individual being in a vulnerable population or a vulnerable situation. We will review further in this training. Note that there are two factors that automatically place an individual in a vulnerable population, and those are social isolation and presence of dementia or Alzheimer's disease.
00:02:01:28 - 00:02:34:13
Unknown
Physical abuse can take on many forms. Physical abuse involves causing physical pain or injury to a vulnerable person by the use of physical force. Physical abuse can include, but is not limited to hitting, slapping, pushing, shaking, kicking, burning. Inappropriate use of drugs or physical restraints. Force feeding. Physical punishment. Homicide. Strangled. And suffocation. Confinement. Restraining or isolating a vulnerable person for any reason other than medical necessity.
00:02:35:10 - 00:03:02:00
Unknown
Deprivation and neglect have some common features, but are different. Let's explore them both. Deprivation is denying a vulnerable person medication, medical care, shelter, food needed medical equipment, slashed supplies, physical assistance, or exposing the person to physical, mental or emotional harm. Neglect is the failure to provide care or address the basic needs food, water, clothing and shelter of a vulnerable person.
00:03:02:25 - 00:03:36:01
Unknown
It can be intentional or unintentional and can also be self-inflicted. Self neglect is when a person fails to provide themselves with basic necessities and care, resulting in a risk to their health, safety or well-being. Emotional abuse is also varied in types, but often involves verbal assaults, threats of abuse, harassment, intimidation and or embarrassment. Financial abuse or exploitation is the misappropriation or misuse of a vulnerable persons money, property or resources.
00:03:36:22 - 00:04:02:21
Unknown
This is often conducted by a person who stands in a position of trust and confidence with the vulnerable person can involve the use of deception, intimidation or force. Sexual abuse is the touching, fondling, intercourse or any other sexual activity with a vulnerable person that is unable to understand or consent to such activity? Now that we have an understanding of the terms, let's get into what are some risk factors?
00:04:03:17 - 00:04:27:05
Unknown
Risk factors help us to understand and recognize situations in which abuse may be more likely to occur. Our risk factors are in two categories those that are unique to caregivers and then to members. Often, caregivers set out caring for their loved ones with the best of intentions. However, stress, combined with a multitude of other factors, can lead to abusive situations.
00:04:28:02 - 00:04:53:20
Unknown
Some of those factors include, but are not limited to alcohol and or substance abuse, mental illness, stress, lack of resources, education or support, physical limitations, health conditions, history of domestic violence or child abuse. Problems with housing, finances and or employment. Multiple demands from work dependance, family, etc.. As you can imagine, caring for another person takes time, attention and energy, which can be overwhelming and stressful.
00:04:54:15 - 00:05:21:06
Unknown
When you have a caregiver that is devoting their time and attention without support, this is a situation that could have a potential risk for abusive behavior. Earlier, we talked about two factors that increase a vulnerable person's risk for being abused. Those are social isolation and mental impairment, such as a diagnosis of dementia or Alzheimer's. Recent studies show that nearly half of those with dementia experienced abuse or neglect.
00:05:22:04 - 00:05:53:02
Unknown
Members that are isolated socially and members that have a mental impairment are unfortunately a target for abuse. Each of us can look out for these risk factors as well as members who are elderly or underage members. Members who do not understand or are not aware of their rights. Members who are depressed, have anxiety or other mental health issues, have limited mental capacity, are dependent on others financially or for care or help, have health conditions, have experienced the loss of a primary caregiver or a spouse and members with sensory impairments.
00:05:53:29 - 00:06:12:04
Unknown
Members may have a single or multiple risk factors that placed them at a higher risk for abuse, neglect or exploitation. Keep in mind that vulnerable adults who have experienced a form of abuse have a 300% higher risk for death than those who have not experienced abuse.
00:06:14:18 - 00:07:02:14
Unknown
Now that we understand the terms and the situations that lead to abuse, let's examine the specific warning signs that abuse is occurring. Some physical signs and symptoms that physical abuse can possibly be occurring are bruises, bleeding spots, burns marks, cuts, scrapes, broken bones, injuries, broken or missing sensory aids, torn clothing, dehydration or unusual weight loss, unsanitary or unsafe living conditions, poor hygiene, unattended medical needs, unintentional weight loss wearing clothing that are not appropriate for the weather or environment.
00:07:03:11 - 00:07:26:22
Unknown
Bedsores or pressure ulcers. Lack of funds for food, rent or mortgage bills or medications. Lack of utilities or utilities have been turned off. In other words, injuries or problems that are unexplained or do not coincide with the explanation given. This is not to say that any of these signs are definitive indications of abuse. They are warning signs of things.
00:07:26:22 - 00:07:59:29
Unknown
We need to pay attention to emotional signs that abuse is possibly occurring, appears fearful of caregiver, suddenly withdrawn or shy, avoiding answering questions, being overly complimentary of caregiver or suddenly criticizing caregiver stops, engaging in activities or socialization. Sudden onset of aggression, anger or agitation. Comments that caregiver is not listening. Treating member like a child. Critical harassing. Interrupting. Talking for a member.
00:07:59:29 - 00:08:35:29
Unknown
Demanding ignoring member stops. Talking when caregiver enters the room. Defers answering questions to caregiver who should report? State laws require certain people to report concerns of abuse, neglect and exploitation or other suspected acts of harm towards adults or children to appropriate authorities, agencies or other protective services. These requirements to report are often referred to as duties to report, and the individuals who are required to report are often referred to as mandated reporters.
00:08:36:26 - 00:09:05:23
Unknown
Some states require reporting by any person, but many states identify specific professionals as mandated reporters, which can include social workers, mental health professionals, medical professionals, or other individuals holding a professional license. If you have knowledge or information about our members during the course of your employment with Humana and you're uncertain whether you have a duty to report or a duty to warn or protect, you can promptly consult the appropriate governing body which regulates your profession.
00:09:06:20 - 00:09:33:24
Unknown
If you have suspicions of abuse, neglect or exploitation, notify the appropriate authorities, agencies and other protective services immediately. You are then required to immediately report internally by adhering to the following steps. One. Complete an occurrence report via the Humana Risk Management Occurrence Reporting System. If the situation involves a medicaid member, please select the critical incident Medicaid and LTC only occurrence type.
00:09:33:25 - 00:09:58:11
Unknown
When prompted to refer to the complete list of reportable occurrences for internal reporting by visiting the Risk Management SharePoint site, go slash rm3. Risk Management will notify the Privacy Office of any disclosures of HI upon submission of an incident report to the Risk Management Occurrence Reporting system. Be sure to include the following information in your report to risk Management.
00:09:59:07 - 00:10:25:15
Unknown
One Name of member two Name of organization contact where information was disclosed. Three Member ID. Four Date of Disclosure. Five Brief Description of Purpose and Content of Disclosure. Remember, in every interaction you have with a member to be aware of any signs for abuse, neglect and exploitation, you may be the only person in that member's life who is looking out for them.
00:10:26:11 - 00:10:36:04
Unknown
Our duty is to protect our members. For more information on any of the topics reviewed in this training, consult the following resources.
- 2022 Health, Safety and Welfare Training
- 2022 Cultural Competency Training
For subcontractors serving Humana Healthy Horizons plans in Florida, Kentucky, Louisiana, Ohio and/or South Carolina or a duals plan in Illinois
If you are subcontracted to provide services for a Medicaid plan administered by Humana Healthy Horizons in Florida, Kentucky, Louisiana, Ohio and/or South Carolina or a duals plan in Illinois, you are required to take the applicable modules below. Your training may include any or all of the modules, depending on the state(s) in which you are contracted.
- Abuse, Neglect, and Exploitation (ANE) Training
- Florida, Illinois, Kentucky, Louisiana, Ohio, and/or South Carolina
00:00:00:10 - 00:00:27:25
Unknown
Welcome to the abuse, neglect and exploitation training. As you can imagine, abuse, neglect and exploitation is an extremely important topic for all of us working in Medicaid to be knowledgeable about. Within each of our roles, we should understand each a new term and understand the impact that abuse, neglect and exploitation can have on the vulnerable populations we serve and know what the signs and symptoms to look for.
00:00:28:21 - 00:00:54:00
Unknown
We will go through each of these in this training module as well as some scenarios for you to then test out your skills. Ending with additional resources. Abuse of a vulnerable population is a prevalent problem that often affects the victim as well as those around them. According to the National Council on Aging, up to 5 million older adults experienced some form of abuse, neglect or exploitation.
00:00:54:00 - 00:01:27:09
Unknown
In America every year. That abuse could occur in any location, including at home, at a facility or while out in the community. 60% of abusers are often family members. But what can we do? We can be knowledgeable about all the forms abuse can take, look out for signs of abuse and offer resources and help. Further statistics show that on average, one in ten individuals over the age of 60 have experienced a form of abuse and only a small percentage of which are then reported to the authorities.
00:01:28:09 - 00:02:00:27
Unknown
A vulnerable population includes those individuals that are in a racial or ethnic minority group children, elderly, socioeconomically disadvantaged, under-insured and uninsured, and those with certain medical conditions. This is not a comprehensive list, as there are many factors that contribute to an individual being in a vulnerable population or a vulnerable situation. We will review further in this training. Note that there are two factors that automatically place an individual in a vulnerable population, and those are social isolation and presence of dementia or Alzheimer's disease.
00:02:01:28 - 00:02:34:13
Unknown
Physical abuse can take on many forms. Physical abuse involves causing physical pain or injury to a vulnerable person by the use of physical force. Physical abuse can include, but is not limited to hitting, slapping, pushing, shaking, kicking, burning. Inappropriate use of drugs or physical restraints. Force feeding. Physical punishment. Homicide. Strangled. And suffocation. Confinement. Restraining or isolating a vulnerable person for any reason other than medical necessity.
00:02:35:10 - 00:03:02:00
Unknown
Deprivation and neglect have some common features, but are different. Let's explore them both. Deprivation is denying a vulnerable person medication, medical care, shelter, food needed medical equipment, slashed supplies, physical assistance, or exposing the person to physical, mental or emotional harm. Neglect is the failure to provide care or address the basic needs food, water, clothing and shelter of a vulnerable person.
00:03:02:25 - 00:03:36:01
Unknown
It can be intentional or unintentional and can also be self-inflicted. Self neglect is when a person fails to provide themselves with basic necessities and care, resulting in a risk to their health, safety or well-being. Emotional abuse is also varied in types, but often involves verbal assaults, threats of abuse, harassment, intimidation and or embarrassment. Financial abuse or exploitation is the misappropriation or misuse of a vulnerable persons money, property or resources.
00:03:36:22 - 00:04:02:21
Unknown
This is often conducted by a person who stands in a position of trust and confidence with the vulnerable person can involve the use of deception, intimidation or force. Sexual abuse is the touching, fondling, intercourse or any other sexual activity with a vulnerable person that is unable to understand or consent to such activity? Now that we have an understanding of the terms, let's get into what are some risk factors?
00:04:03:17 - 00:04:27:05
Unknown
Risk factors help us to understand and recognize situations in which abuse may be more likely to occur. Our risk factors are in two categories those that are unique to caregivers and then to members. Often, caregivers set out caring for their loved ones with the best of intentions. However, stress, combined with a multitude of other factors, can lead to abusive situations.
00:04:28:02 - 00:04:53:20
Unknown
Some of those factors include, but are not limited to alcohol and or substance abuse, mental illness, stress, lack of resources, education or support, physical limitations, health conditions, history of domestic violence or child abuse. Problems with housing, finances and or employment. Multiple demands from work dependance, family, etc.. As you can imagine, caring for another person takes time, attention and energy, which can be overwhelming and stressful.
00:04:54:15 - 00:05:21:06
Unknown
When you have a caregiver that is devoting their time and attention without support, this is a situation that could have a potential risk for abusive behavior. Earlier, we talked about two factors that increase a vulnerable person's risk for being abused. Those are social isolation and mental impairment, such as a diagnosis of dementia or Alzheimer's. Recent studies show that nearly half of those with dementia experienced abuse or neglect.
00:05:22:04 - 00:05:53:02
Unknown
Members that are isolated socially and members that have a mental impairment are unfortunately a target for abuse. Each of us can look out for these risk factors as well as members who are elderly or underage members. Members who do not understand or are not aware of their rights. Members who are depressed, have anxiety or other mental health issues, have limited mental capacity, are dependent on others financially or for care or help, have health conditions, have experienced the loss of a primary caregiver or a spouse and members with sensory impairments.
00:05:53:29 - 00:06:12:04
Unknown
Members may have a single or multiple risk factors that placed them at a higher risk for abuse, neglect or exploitation. Keep in mind that vulnerable adults who have experienced a form of abuse have a 300% higher risk for death than those who have not experienced abuse.
00:06:14:18 - 00:07:02:14
Unknown
Now that we understand the terms and the situations that lead to abuse, let's examine the specific warning signs that abuse is occurring. Some physical signs and symptoms that physical abuse can possibly be occurring are bruises, bleeding spots, burns marks, cuts, scrapes, broken bones, injuries, broken or missing sensory aids, torn clothing, dehydration or unusual weight loss, unsanitary or unsafe living conditions, poor hygiene, unattended medical needs, unintentional weight loss wearing clothing that are not appropriate for the weather or environment.
00:07:03:11 - 00:07:26:22
Unknown
Bedsores or pressure ulcers. Lack of funds for food, rent or mortgage bills or medications. Lack of utilities or utilities have been turned off. In other words, injuries or problems that are unexplained or do not coincide with the explanation given. This is not to say that any of these signs are definitive indications of abuse. They are warning signs of things.
00:07:26:22 - 00:07:59:29
Unknown
We need to pay attention to emotional signs that abuse is possibly occurring, appears fearful of caregiver, suddenly withdrawn or shy, avoiding answering questions, being overly complimentary of caregiver or suddenly criticizing caregiver stops, engaging in activities or socialization. Sudden onset of aggression, anger or agitation. Comments that caregiver is not listening. Treating member like a child. Critical harassing. Interrupting. Talking for a member.
00:07:59:29 - 00:08:35:29
Unknown
Demanding ignoring member stops. Talking when caregiver enters the room. Defers answering questions to caregiver who should report? State laws require certain people to report concerns of abuse, neglect and exploitation or other suspected acts of harm towards adults or children to appropriate authorities, agencies or other protective services. These requirements to report are often referred to as duties to report, and the individuals who are required to report are often referred to as mandated reporters.
00:08:36:26 - 00:09:05:23
Unknown
Some states require reporting by any person, but many states identify specific professionals as mandated reporters, which can include social workers, mental health professionals, medical professionals, or other individuals holding a professional license. If you have knowledge or information about our members during the course of your employment with Humana and you're uncertain whether you have a duty to report or a duty to warn or protect, you can promptly consult the appropriate governing body which regulates your profession.
00:09:06:20 - 00:09:33:24
Unknown
If you have suspicions of abuse, neglect or exploitation, notify the appropriate authorities, agencies and other protective services immediately. You are then required to immediately report internally by adhering to the following steps. One. Complete an occurrence report via the Humana Risk Management Occurrence Reporting System. If the situation involves a medicaid member, please select the critical incident Medicaid and LTC only occurrence type.
00:09:33:25 - 00:09:58:11
Unknown
When prompted to refer to the complete list of reportable occurrences for internal reporting by visiting the Risk Management SharePoint site, go slash rm3. Risk Management will notify the Privacy Office of any disclosures of HI upon submission of an incident report to the Risk Management Occurrence Reporting system. Be sure to include the following information in your report to risk Management.
00:09:59:07 - 00:10:25:15
Unknown
One Name of member two Name of organization contact where information was disclosed. Three Member ID. Four Date of Disclosure. Five Brief Description of Purpose and Content of Disclosure. Remember, in every interaction you have with a member to be aware of any signs for abuse, neglect and exploitation, you may be the only person in that member's life who is looking out for them.
00:10:26:11 - 00:10:36:04
Unknown
Our duty is to protect our members. For more information on any of the topics reviewed in this training, consult the following resources.
- Health, Safety and Welfare Training
Cultural Competency Training, PDF Medicare Fraud and Abuse: Prevent, Detect, Report
You also are required to take the following state-specific trainings in the states where you are subcontracted to provide services:
Attestation required for Medicaid training
All providers (contracted or subcontracted) serving patients with Humana Healthy Horizons Medicaid plans in Florida, Kentucky, Ohio and/or South Carolina or patients with Humana Illinois Medicare-Medicaid plans must submit an attestation to certify adherence to Medicaid training requirements.
To complete your compliance training and attestation online (unless otherwise instructed):
- Log into Availity.com
- Select Payer Spaces – Humana
- Select the ‘Resources’ tab
- Select “Humana Compliance Events’
- Select ‘I agree’ to the notice that pops up to indicate you are leaving Availity’s website.
- If a security warning pops up indicating that you are navigating to
https://sso2.archer.rsa.com , choose ‘Yes’ to proceed. You will be entering Humana’s secured compliance portal. - Follow the on-screen instructions to add, review and accept the compliance events.
- Sign out in the upper right corner of the screen when all applicable events show ‘Complete.”
Content Requiring Annual Review (No attestation required)
- , PDF opens new window
- , PDF opens new window
- , PDF opens new window
-
Fraud, Waste and Abuse (FWA)
If your organization supports Humana’s Medicare Advantage, prescription drug and/or Medicaid plans, CMS and Humana require that your employees be trained on FWA at orientation and annually thereafter.
Your organization can create and train on its own FWA content, or it can use content provided on CMS’ website. Supplemental material for addressing FWA is available in Humana’s Ethics Every Day and Compliance Policy documents, above.
*Important: Humana reserves the right to request evidence at any time that an organization’s FWA training is occurring, that the organization is tracking the training, and that the organization has documented processes for the training and tracking.
Please remember to complete the compliance requirements within 30 days of notification.
If a practitioner or anyone employed by or contracted with a Humana-contracted provider suspects actions of noncompliance and/or fraud, waste and abuse, he or she must report it immediately. This may be done confidentially via the Ethics Help Line at 877-5THE KEY (877-584-3539), through the , opens new window or by a separate method, preferred by the contracted party, that must then forward the information to Humana promptly.
Why the training is required and how to complete the required compliance attestation
Review and confirmation of the SNP and Medicaid-related training materials help practitioners comply with state and federal law, other government requirements and Humana's policies and procedures. Therefore, applicable parties must share required information with their employees and, when applicable, with contracted (nonemployee) individuals and any subcontracted entities that support any of the following Humana plan types: Medicare, Medicaid (Humana Healthy Horizons), Medicare-Medicaid dual plans, MA SNPs.
There are separate attestations for SNP and other types of training with a Medicaid component, but each attestation should be completed at the contract level. That is, each practitioner in an organization with a direct contract with Humana must separately complete the required attestation. However, if a practitioner is contracted with Humana only through a group contract, the organization will need to have a person responsible for compliance complete the required attestation. Please note that if an organization performs multiple functions for Humana, its compliance contact may receive an additional notification from Humana; however, the organization is only required to complete each applicable attestation once per year.
Any contracted party needing to complete a Humana attestation may do so online via Humana's secure compliance website. To access the website, the contracted party represented must be registered on
The information below can help you meet the requirement:
This document provides additional information regarding the compliance requirements and related online resources.
This document covers the process for completing compliance requirements on Availity.com, including how to register, how to create a new user, how to assign the compliance business function to another user and how to update an organization's Tax Identification Number.
If your organization is unable to register on Availity.com, refer to the following document: