2019 Member Handbook Serving Kentucky Medicaid Benefit Plans IMPORTANT NEXT STEPS

2019 Member Handbook Serving Kentucky Medicaid Benefit Plans IMPORTANT NEXT STEPS • Look for your ID card in the mail (page 4) - It will come in a separate mailing • Make an appointment to see your doctor (page 24) • Read about your covered services and benefits (page 7) - Information is also available on our website at CareSource.com/KY • Fill out your Health Risk Assessment (HRA) - A copy is included in this mailing - You can also fill it out online: • CareSource.com/members/kentucky/medicaid/ • Click on “Health Survey” under Quick Links to get started Thank you for being a Humana – CareSource member! It is our pleasure to serve you! Humana – CareSource | 2019 Member Handbook TABLE OF CONTENTS Medicaid State Plan Information ................................................................................. 4 Member ID Card. ................................................................................................ 4 Services: What is Covered .......................................................................................... 6 Detailed Benefits Chart ....................................................................................... 6 Prior Authorization .............................................................................................. 6 Covered Services: .............................................................................................. 7 Services: What is Not Covered ......................................................................... 14 General Information for all our members .................................................................. 15 Added Benefits/Self-Service Tools ................................................................... 17 myStrength ....................................................................................................... 17 MyCareSource .................................................................................................. 18 Contact Us ........................................................................................................ 18 Member Services and CareSource.com ................................................................... 20 Interpreter Services .......................................................................................... 22 Other Insurance? ...................................................................................................... 23 Loss of Medicaid ............................................................................................... 23 24-Hour Nurse Advice Line ....................................................................................... 23 Your Primary Care Provider (PCP) ............................................................................ 24 Choosing a PCP ............................................................................................... 24 What happens if you don’t choose a PCP? ...................................................... 24 Special Cases: .................................................................................................. 25 Changing Your PCP or Specialist ..................................................................... 25 Doctor Visits ..................................................................................................... 26 Provider Directory ..................................................................................................... 27 Find-a-Doctor .................................................................................................... 27 Referrals are not Required ................................................................................ 27 Using a provider that is not in our network ........................................................ 28 Where to Get Medical Care ...................................................................................... 29 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) .......................... 30 EPSDT Preventive Care ................................................................................... 30 CareSource.com/KY 1 Humana – CareSource | 2019 Member Handbook Should I go to the Emergency Room? ...................................................................... 33 Post-Stabilization Care ..................................................................................... 34 Long-Term Care ................................................................................................ 35 Second Opinions .............................................................................................. 35 Pregnancy and Family Planning ............................................................................... 36 Sexually Transmitted Diseases ......................................................................... 36 Family Planning Services ................................................................................. 36 Before You Are Pregnant .................................................................................. 36 After Your Baby is Born .................................................................................... 37 Prescription Drugs .................................................................................................... 38 Specialty Pharmacy .......................................................................................... 39 Medication Therapy Management .................................................................... 39 Behavioral Health Services ....................................................................................... 41 Care Management and Outreach Services ............................................................... 42 Disease Management ....................................................................................... 42 Tobacco Free Program ..................................................................................... 43 Care Transitions ................................................................................................ 43 Grievances and Appeals ........................................................................................... 44 Grievances (Complaints) ................................................................................... 44 Appeals............................................................................................................. 45 State Fair Hearings ........................................................................................... 47 Ombudsman ..................................................................................................... 47 Fraud, Waste and Abuse .......................................................................................... 48 If You Suspect Fraud, Waste or Abuse ............................................................. 49 Kentucky Lock-In Program (KLIP) ............................................................................. 50 Quality Health Care .................................................................................................. 50 Quality Improvement ................................................................................................ 52 Program Purpose .............................................................................................. 52 Program Scope ................................................................................................. 52 Quality Measures .............................................................................................. 53 Preventive Guidelines and Clinical Practice Guidelines .................................... 54 Your Health is Important ................................................................................... 55 2 CareSource.com/KY Humana – CareSource | 2019 Member Handbook Your Rights ............................................................................................................... 56 Your Responsibilities ................................................................................................. 58 Notice of Privacy Practices ....................................................................................... 60 Your Individual Privacy Rights under HIPAA ..................................................... 64 Advance Directives ................................................................................................... 68 Advance Directives in Kentucky ....................................................................... 68 Living Will ......................................................................................................... 68 Mental Health Treatment Directive ................................................................... 69 Guardianship .................................................................................................... 70 Ending Your Membership ...........................................................................................71 Word Meanings ..........................................................................................................71 CareSource.com/KY 3 if you have Humana – CareSource | 2019 Member Handbook 1-855-852-7005 MEDICAID STATE PLAN INFORMATION KY-HUCM0-1470 KDMS Approved 7/25/2017 Medicaid State Plan Member ID Card Humana – CareSource gives all members an ID card. Your State Plan member ID card looks like this. The front side has personal information. The card also has key Attached is your new Humana – CareSource ID card. We Attached is your new Humana – CareSource ID card. We are sending you a new card because

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