ECHO Home Health Care

ECHO-registered beneficiaries may qualify for the ECHO Home Health Care (EHHC) benefit when he or she:

  • Is homeboundTRICARE considers you homebound if you can’t leave your home without a lot of effort.
  • Requires skilled services beyond the level of coverage provided by the TRICARE Home Health Care Prospective Payment System.
  • Has frequent interventions from his or her primary caregiver (s)
  • Has a case manager who occasionally reviews needs and required services.
  • Has a physician-approved plan of care that details services provided.

The EHHC benefit is only available in the United States, District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.

You will need a referral or prescription before obtaining certain services. Contact your primary care manager if using TRICARE Prime or your family provider if using TRICARE Select. Your primary care manager or attending physician:

  • Decides if you’re eligible for EHHC services.
  • Develops a plan of care.

The patient’s physician, case manager and/or regional contractor will review the plan every 90 days or when there is a change in the patient’s condition.

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 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

Primary caregiversAnyone who takes care of the patient at home and helps with daily activities. may use respite care for temporary relief or rest when caring for a homebound beneficiary who requires frequent care.

Primary caregivers may qualify for:

  • 8 hours of respite care, 5 days per calendar week.
  • This benefit is different from the ECHO’s 16 hours of respite care available and beneficiaries can't use both during the same month.
  • You can’t use EHHC respite care for childcare services, sibling-care, employment, deployment or pursuing education.
  • You can’t store up unused respite care hours.

Benefit Cap

  • Your coverage for the EHHC benefit is capped on a yearly basis.
  • TRICARE will pay up to the amount it would cost if the beneficiary resided in a skilled nursing facility.
  • This amount is based on your physical location.

 

Last Updated 3/21/2022