Inpatient Behavioral Health Care Services
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Prior authorization from Humana Military is required for all nonemergency inpatient behavioral health care services. Psychiatric emergencies do not require prior authorization for admission to an inpatient unit, but authorization is required for continued stay. Admissions resulting from psychiatric emergencies should be reported to Humana Military within 24 hours of admission or the next business day, and must be reported within 72 hours of an admission. Authorization for continued stay is coordinated between the inpatient unit and Humana Military.
Note: ADSMs who receive care at MTFs do not require prior authorization. Behavioral Health Care Services: Inpatient Coverage Details
| Service |
Description |
Hospitalization
(semiprivate room/special care units when medically necessary) |
Covers general nursing; hospital, physician, and surgical services; meals (including special diets); drugs and medications; operating and recovery room care; anesthesia; laboratory tests; X-rays and other radiology services; medical supplies and appliances; and blood and blood products.
Note: Surgical procedures designated “inpatient only” may only be covered when performed in an inpatient setting.
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Skilled Nursing Facility Care
(semiprivate room) |
Covers skilled nursing services; meals (including special diets); physical, occupational, and speech therapy; drugs furnished by the facility; and necessary medical supplies and appliances (TRICARE covers an unlimited number of days as medically necessary.)
Note: TRICARE does not cover purely custodial care. |
| Residential Treatment Center (RTC) Care |
RTC care provides extended care for children and adolescents with psychological disorders that require continued treatment in a therapeutic environment. The following rules apply:
- Facilities must be TRICARE-authorized.
- Unless therapeutically contraindicated, the family and/or guardian should actively participate in the continuing care of the patient through either direct involvement at the facility or geographically distant family therapy.
- Prior authorization from Humana Military is always required. RTC admissions are not considered emergencies.
- RTC care is considered elective and will not be covered for emergencies.
- Admission primarily for substance use rehabilitation is not authorized for psychiatric RTC care.
- Care must be recommended and directed by a psychiatrist or clinical psychologist.
Limitations:
- Care is limited to 150 days per FY1 or for a single admission. (Limitations may be waived if determined to be medically or psychologically necessary.)
- RTC care is only covered for patients up to age 21.
- RTC care does not count toward the 30- or 45-day inpatient limit.
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1 October 1–September 30.
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