ECHO Home Health Care
ECHO-registered beneficiaries may qualify for the ECHO Home Health Care (EHHC) benefit when they:
- Are homeboundTRICARE considers you homebound if you can’t leave your home without a lot of effort..
- Require skilled services beyond the level of coverage that TRICARE Home Health Care Prospective Payment System (THHCPPS) provides.
- Require frequent interventions that their primary caregiver normally provides.
- Have a case manager who periodically assesses their needs and required services.
- Have a physician-certified plan of care that details the services that are provided.
The EHHC benefit is only available in the United States, District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.
You’ll need a referral or prescription before obtaining certain EHHC services. Contact your primary care manager (PCM) if you’re using TRICARE Prime, contact your family provider if you have TRICARE Select. Your primary care manager or attending physician:
- Decides eligibility for EHHC services.
- Develops a plan of care.
Your physician, case manager and/or regional contractor reviews your plan:
- Every 90 days, or
- When there is a change in your condition.
EHHC may cover the following services when they are provided by a TRICARE-authorized home health agency in the your 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 aide 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
If you are the primary caregiver of a TRICARE beneficiary who is homebound and requires frequent care, you might qualify for respite care. Respite care can give you temporary relief or rest for up to 8 hours per day, 5 days per week.
- You can’t use EHHC respite care for child care services, sibling-care, employment, deployment or pursuing education.
- Unused respite care hours can’t accumulate.
- ECHO’s 16 hours of respite care differs from EHHC. You can’t use the two benefits during the same month.
- EHHC benefit coverage caps out on an annual basis.
- TRICARE coverage caps out at the maximum amount TRICARE would pay if you resided in a skilled nursing facility.
- Your geographic location determines the amount.
Note: Are you covered by Custodial CareNon-skilled, personal care for basic day-to-day tasks. This includes help with eating, dressing, getting in or out of a bed or chair, moving around, and using the bathroom. Transition Program (CCTP) and need medical services that EHHC doesn’t provide? You can keep your CCTP coverage and your PCM and regional contractor will review your care each year .
Last Updated 10/11/2022