Tricare Home Health Care coverage and benefits

TRICARE’s home health care benefits are similar to those covered under Medicare. To qualify for TRICARE coverage of any home health care services, the patient must meet each of the following criteria:

•     Patient is confined to the home

•     Services are provided under a plan of care established and approved by a physician
•     Patient is under the care of the physician who approved the plan of care

•     Patient needs one of the following types of services:
•     Skilled nursing care that is reasonable and necessary (as defined in the TRICARE
Reimbursement Manual, Chapter 12, Section 2)
•     Psychiatric evaluation, therapy, and teaching (covered as a skilled nursing service)
•     Intermittent skilled nursing care*
•     Skilled therapy services (i.e., physical therapy, speech-language pathology,
or occupational therapy)

If a patient qualifies for coverage of home health care services, TRICARE covers a limited number of hours per week of either part-time or intermittent services. All home health care must be provided by a participating home health care agency.

It is important to note that assistance with activities of daily living (e.g., washing laundry, cleaning dishes) is not part of the home health benefit. While the home health care professional may provide some assistance with basic daily living care, these tasks are not separately reimbursable and are not their primary duties while in the
patient’s home.

You may refer to www.triwest.com/provider to access the Home Health Agency Prospective
Payment System eSeminar. You may view the eSeminar 24 hours a day, seven days a week
from most computers with Internet access