Covered services

Long-term care coverage is limited to those services authorized in writing by the member’s care manager and in accordance with Florida’s Agency for Health Care Administration (AHCA) Medicaid Services Coverage and Limitations handbooks. Covered services include:

Adult day care

Adult day care provides members with supervision, socialization and therapeutic activities in an outpatient setting while offering respite for caregivers. Meals are included as part of this service when the member is at the center during mealtimes. Adult day care health services include, but are not limited to, the following:

Supervised, recreational activities at least 80% of the day
Physical exercises
Cognitive exercises
Lunch and snacks
Coordination of transportation
Medication administration and management
Vital signs monitoring
Basic health monitoring, including glucose level checks
Referral to physical therapy screening (conducted on-site)
Hands-on assistance with personal care, such as toileting, eating, ambulating and grooming

Assistive care

Assistive care offers 24-hour services for members in assisted living facilities, adult family care homes and residential treatment facilities. Services include:

24-hour access to staff
Assistance with ambulation
Assistance with transferring
Assistance with eating
Dementia care
Dressing and grooming
Emergency/disaster plan
Escort services
Housekeeping
Incontinence management
Medication management
Personal laundry and linen services
3 meals per day, plus snacks
Transportation
Utilities
Wander guard

Assisted living facility

Assisted living facilities (ALFs) provide members with an alternative living arrangement that offers members access to 24-hour staff in a home-like environment. Meals, personal care and housekeeping services are provided by the staff. ALFs also may be used for respite care. ALFs provide members with the following services or as indicated in each individual provider contract:

24-hour access to staff
Bathing assistance
Medication management
3 meals per day, plus snacks
Incontinence management
Incontinence supplies
Nutritional supplements
Housekeeping
Personal laundry and linen service
Utilities
Transportation or coordination of transportation
Alarmed doors or locked unit
Personal hygiene items
Escort to dining room
Emergency/disaster plan
Dementia care

Transportation

All Humana Healthy Horizons Comprehensive Plan contracts with ALFs require the ALF to coordinate transportation for members. Humana Healthy Horizons members are eligible for transportation trips to long-term-care-covered services as authorized by Humana Healthy Horizons. Please contact the member’s care manager for authorization approval. Humana Healthy Horizons members should use their health plan ID card for all covered transportation services (including emergency transportation).

Behavioral management

Behavioral management offers behavioral healthcare services to help address mental health or substance use needs of long-term care members. These services are used to maximize reduction of the member’s disability and restoration of the member’s best functional level.

Home accessibility adaption services

Home accessibility adaption services help members make modifications to their home that promote safety and reduce barriers for the member’s treatment plan. Installation of grab bars and ramps, widening doors, modifying bathroom facilities or installing specialized electric and plumbing systems accommodate medical equipment and supplies necessary for the welfare of the member. These services exclude home modifications that may be considered home improvements. All services must be provided in accordance with applicable state and local building codes.

Members or caregivers are contacted within 2 business days of receipt of authorization from the Humana Healthy Horizons care manager to schedule an appointment.

Home-delivered meals

Home-delivered meal services ensure members who are unable to shop or cook receive nutritionally sound meals. Meals are delivered to the home hot, cold, frozen, dried or canned, with a satisfactory storage life. Each meal is designed to provide a third of the recommended dietary allowance. A signature must be obtained from the member or caregiver at the time of meal delivery. Members coordinate changes to their meal delivery through their care manager.

Home healthcare

Providers contracted with Humana Healthy Horizons must adhere to the following procedures when providing services:

Humana Healthy Horizons reserves the right to make decisions regarding the plan of care for its members and request specific services and frequency to meet the member’s needs. Services may be provided in a member’s home or an ALF on an hourly or per-visit fee, as authorized by Humana Healthy Horizons. The home healthcare (HHC) provider has a maximum of 2 hours to inform Humana Healthy Horizons staff if the requested services can be provided and the anticipated start date.
HHC staff are required to complete AHCA’s designated form, verifying that the services were provided at the time of each visit, complete with the member’s signature. The completed form also must include the date and time of service, the member’s signature, and the names of direct care staff who provided the service.
In compliance with the 21st Century CURES Act, providers are required to utilize electronic visit verification (EVV) to electronically monitor, track and confirm services provided in the home setting.
If a Humana Healthy Horizons member is entitled to Medicare home health benefits, these benefits are utilized before Humana Healthy Horizons authorizes home health benefits, as described in your contract with Humana Healthy Horizons.
Missed visits must be documented via EVV and reported within 3 hours of the original appointment time.

Home health services are authorized by the care manager on a weekly basis (Sunday through Saturday). Preauthorization is required by the care manager to deliver services that exceed the number of hours authorized in a day or in a week. The only variation allowed without preauthorization is when switching the day(s) of services within the same week with member consent. If the schedule change is permanent, the provider should inform the care manager of the change.

Adult companion

Companions can perform tasks, such as meal preparation, laundry and shopping, while providing socialization for the member. This includes light housekeeping tasks incidental to the care and supervision of the member. Services do not include hands-on nursing care or bathing assistance.

Family training

Family training offers family members advice, demonstrations and tips to promote safety while caring for the member. Topics include diabetes management, how to transfer an individual and how to use safety equipment properly.

Homemaker services

Homemaker services support members with general household activities, including meal preparation, laundry and light housekeeping.

Occupational therapy

Occupational therapy works to restore, improve or maintain impaired function for daily living tasks (e.g., using a fork, using a shower chair or cooking from a wheelchair).

Personal care

Personal care service helps members bathe, dress, eat, maintain personal hygiene and assists in other activities of daily living. A personal care worker is permitted to help with incidental housekeeping, such as making beds and cleaning up areas where they performed services.

Physical therapy

Physical therapy works to restore, improve or maintain impaired function in regard to ambulation and mobility, including walking, transferring to or using a walker or wheelchair.

Respite care

Respite care services help caregivers get relief from their caretaking duties for short periods of time. Respite care may be provided by a home health agency, assisted living community or a skilled nursing facility. Respite care is not a substitute for care usually provided by a registered nurse, a licensed practical nurse or a therapist.

Hospice

Hospice delivers forms of palliative medical care and other services designed to meet the physical, social, psychological, emotional and spiritual needs of terminally ill members and their families. Care managers coordinate this care with members enrolled in Medicare hospice services. If a member requires any hospice service traditionally covered by Medicaid, preauthorization may be required from the care manager.

Members can be simultaneously enrolled in Humana Healthy Horizons and hospice. Medicaid hospice services require prior approval from Humana Healthy Horizons. Dual-eligible members may enroll in Medicare hospice; in these instances, the care manager coordinates services. Members or their representatives are required to contact the Humana Healthy Horizons care manager before enrolling in a hospice program.

Medical supplies

Consumable

Consumable medical supplies include adult disposable diapers, tubes of ointment, cotton balls and alcohol for use of injections, medicated bandages, gauze and tape, colostomy, catheter and other consumable supplies not covered by Medicare. Supplies covered under home health service, or personal toiletries and household items, including detergents, bleach, paper towels or prescription drugs, are not covered. This service does not include personal toiletries, over-the-counter medications or household items.

The consumable medical supply service requires written authorization from the Humana Healthy Horizons care manager. Supplies are delivered to the member’s home and the member or caregiver must sign an itemized receipt. Members must go through their care manager to make changes to an order. Nutritional supplements require both a provider’s prescription and preauthorization from the Humana Healthy Horizons care manager. Members authorized to live in a contracted facility receive this service directly from the facility.

Durable medical equipment

Durable medical equipment (DME) is medical equipment that can withstand repeated use, is primarily and customarily used to serve a medical purpose, is generally not useful in the absence of illness or injury and is appropriate for use in the recipient’s home. Medicare and Medicaid acute-care programs cover most DME that Humana Healthy Horizons members need. Items needed by Humana Healthy Horizons members not covered by Medicare require preauthorization from the Humana Healthy Horizons care manager.

Skilled nursing facility services

Skilled nursing facility (SNF) services are coordinated with members’ acute-care coverage. If members are dually eligible for Medicare and Medicaid, Humana Healthy Horizons is responsible for coinsurance as per Medicaid crossover guidelines.

Claims must be submitted with the Medicare Explanation of Benefits (EOB).

SNF staff are expected to inform Humana Healthy Horizons staff of changes or concerns identified while providing services to members to ensure that members’ needs are met.

Respite care

Respite care offers caregivers relief from caregiving responsibilities for short periods of time. Respite care may be provided by a SNF. Respite care is not a substitute for the care usually provided by a registered nurse, a licensed practical nurse or a therapist.

Transportation

All Humana Healthy Horizons contracts with SNFs require the SNF to coordinate transportation for our members. Humana Healthy Horizons members are eligible for transportation to long-term-care-covered services, as authorized by Humana. Please contact the member’s care manager for authorization approval. Our members use their health plan ID card for all covered transportation services (including emergency transportation).

Change in member needs

Providers must inform Humana Healthy Horizons staff of changes or concerns they identify while providing services to members to ensure that members’ needs are met. This includes notification of members’ admission to a hospital and/or entering a Medicare or Medicaid hospice program. Medicaid hospice services require preauthorization from Humana Healthy Horizons. Notification must be made within 24 hours of a significant change in members’ healthcare needs.

Custodial care

All members who require custodial care must be assessed and Humana Healthy Horizons must determine that the member can no longer live in a less restrictive setting. Members who receive approval for placement in a contracted SNF for custodial care are required to pay the facility a patient responsibility amount based on their income, determined by the Department of Children and Families. Prior authorization is required by Humana.

Nutrition assessment/ risk reduction

Nutrition assessment and risk reduction services offers members an assessment, hands-on care and guidance for the caregiver and members to address the members’ nutritional needs. Nutritional assessments are made by dietitians, usually from a home health agency. Humana Healthy Horizons reserves the right to determine the plan of care for its members and send a request for specific services and at a frequency to meet members’ needs. Services may be provided in members’ homes or assisted living facilities on a 15-minute increment fee as authorized by Humana.

Personal emergency response system

Personal emergency response system (PERS) services installs and maintains an electronic device that enables members at high risk of institutionalization to secure help in an emergency.

A PERS is connected to the member’s phone and programmed to signal a response center once a “help” button is activated. The member also may wear a portable “help” button to allow for mobility. PERS services generally are limited to those members who live alone or are alone for a significant part of the day and who otherwise would require extensive supervision. Providers train Humana Healthy Horizons members on the use and monthly testing of the unit after installation and notify Humana via telephone or fax if a member utilizes the system.

Providers are expected to install a medical alert system within 5 business days after receiving written authorization from a Humana Healthy Horizons care manager.

Pharmacy benefits

Humana Healthy Horizons offers an over-the-counter (OTC) medication benefit to our members via our mail-order service, PrescribeIT® Rx. Members can find the OTC order form online. Refer to the member handbook for additional information.

Humana Healthy Horizons in Florida 2025 Health and Wellness Catalog and Order Form – English

Humana Healthy Horizons in Florida 2025 Health and Wellness Catalog and Order Form – English and Spanish

Quality enhancements

Quality enhancements are education and/or community-based services coordinated by the care manager to address concerns related to safety measures in the home, fall prevention, disease management, education on end-of-life issues, advance directives and domestic violence.

Transportation

Humana Healthy Horizons members are eligible for transportation to long-term-care-covered services, as authorized by Humana. Please contact the plan for authorization approval. Our members use their health plan ID card for all covered transportation services (including emergency transportation).

Transportation for nonmedical appointments can be provided for services but require preauthorization. Please contact the member’s assigned care managers for more details.

Expanded benefits

Expanded services are those services or benefits offered by Humana Healthy Horizons and approved in writing by AHCA that are not otherwise covered or that exceed limits outlined in the Medicaid State Plan, Florida Medicaid Coverage and Limitations Handbooks and the Florida Medicaid Fee Schedules. These services are in excess of the amount, duration and scope of those services listed above. In instances when an expanded benefit is also a Medicaid covered service, Humana Healthy Horizons administers the benefit in accordance with all applicable service standards pursuant to its contract, the Florida Medicaid State Plan and any Medicaid Coverage and Limitations Handbooks. Humana Healthy Horizons members have specific enhanced benefits. Please see the member handbook for benefit descriptions and details.