ECHO Home Health Care

ECHO Home Health Care (EHHC) provides medically-necessary skilled services to those ECHO beneficiaries who are homebound and generally require more than 28 to 35 hours per week of home health services or respite care. The EHHC benefit is only available in the United States, District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.

The patient's primary care manager or attending physician decides if the patient is eligible for EHHC services and will develop a plan of care which will be reviewed by the physician, case manager and/or regional contractor every 90 days or when there is a change in the patient's condition.

In general, beneficiaries are considered homebound if their conditions are such that they can't leave their homes without considerable and taxing effort.  If beneficiaries leave their homes regularly for therapeutic, psychosocial or medical treatment or to attend an accredited, certified adult daycare program, this will not disqualify them from being considered for EHHC eligibility.

Eligibility

Beneficiaries registered in ECHO may receive the EHHC benefit when he or she:

  • Is homebound
  • Requires medically necessary skilled services beyond the level of coverage provided by the TRICARE Home Health Care Prospective Payment System, or
  • Requires frequent interventions that are normally provided by his or her primary caregiver(s)
  • Has a case manager who periodically assesses needs and required services
  • Has a physician-certified plan of care that details services provided

Benefits

The following services may be covered when provided by a TRICARE-authorized home health agency in the beneficiary's home:

  • Skilled nursing care from a registered nurse, or by a licensed or vocational nurse under direct supervision of a registered nurse
  • Services provided by a home health aid under direct supervision of a registered nurse
  • Physical therapy, occupational therapy and speech-language pathology services
  • Medical social services under the direction of a physician
  • Teaching and training activities
  • Medical supplies

EHHC Respite Care

Respite care is designed to provide temporary relief or rest for the primary caregiver of a homebound beneficiary who requires frequent care. Beneficiaries eligible for EHHC Respite Care may receive 8 hours of respite care, 5 days per calendar week. This benefit is different from the 16 hours of respite care available through ECHO and the two cannot be used during the same month. EHHC respite care cannot be used for babysitting/child care services, sibling-care, employment, deployment or pursuing education.  Unused respite care hours can not accumulated.

Benefit Cap

Coverage for the EHHC benefit is capped on an annual basis. The cap is limited to the maximum fiscal year amount TRICARE would pay if the beneficiary resided in a skilled nursing facility. This amount is based on the beneficiary's geographic location.

Covered by the Custodial Care Transition Program (CCTP)?

If you are currently covered by CCTP and need skilled medical services that exceed the levels offered through EHHC, you may continue to receive care under the CCTP for as long as it is necessary. Your primary care manager and regional contractor will review your care annually to make sure you’re receiving the care and services needed.

Last Updated 11/4/2013