Humana Insurance Company-DSNP

The Master Agreement FP131 establishes a comprehensive Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) designed to serve dually eligible beneficiaries throughout Florida. Under this contract, Humana provides integrated Medicare and Medicaid benefits across all 50 Florida counties, with designated service regions (A through F currently active). The scope of covered services encompasses comprehensive Medicaid offerings including behavioral health services, home health care, long-term care, emergency medical services, pharmaceutical coverage, clinic services, and all additional medical services as defined in Florida Medicaid rules and fee schedules. As a Highly Integrated Dual Eligible Special Needs Plan (HIDE), the contract obligates Humana to cover Medicaid payment of Medicare cost-sharing for eligible beneficiary categories including QMB, QMB Plus, SLMB Plus, FBDE, QDWI, QI, and SLMB populations. The plan further requires establishment of comprehensive enrollee support infrastructure including toll-free multilingual assistance with TTY/TDD capability, integrated care coordination and case management services, and monthly updated provider directories in compliance with federal regulations.

Humana Inc. serves as the prime contractor for this Master Agreement under the administration of the Florida Agency for Health Care Administration (AHCA). The contract operates under CMS contract number H5216 (Plan Benefit Package 394) designated as HumanaChoice Florida SNP-DE and became effective January 1, 2026, with a completion date of December 31, 2028, providing a three-year period of performance. The contract structure is classified as a Master Agreement and covers the entire state of Florida (FL), with specific service rates subject to Centers for Medicare & Medicaid Services approval as outlined in the contract exhibits.