ECHO Home Health Care
ECHO-registered beneficiaries may qualify for the ECHO Home Health Care 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
- 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
The EHHC benefit is only available in the United States, District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.
A referral or prescription is needed before obtaining certain services. Contact your primary care manager if using TRICARE Prime or your family provider if using TRICARE Select. The patient's primary care manager or attending physician:
- Decides if the patient is eligible for EHHC services
- Develops a plan of care
The plan is reviewed by the physician, case manager and/or regional contractor every 90 days or when there is a change in the patient's condition.
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.
Primary caregiversAnyone who takes care of the patient at home and helps with daily activities. may qualify for:
- 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 can't be used during the same month.
- EHHC respite care can't be used for child care services, sibling-care, employment, deployment or pursuing education.
- Unused respite care hours can not accumulated.
- Coverage for the EHHC benefit is capped on an annual basis.
- The cap is limited to the maximum amount TRICARE would pay if the beneficiary resided in a skilled nursing facility.
- This amount is based on the beneficiary's geographic location.
If you're currently covered by CCTP and need skilled medical services that exceed the levels offered through EHHC, you may continue to receive care under 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 you need.
Last Updated 11/29/2017