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TRICARE Brings Health Care Home (Article 11)
What Home Health Agencies Need to Know
 

In the past, TRICARE’s home health care was a fee-for-service reimbursement benefit based solely on medical necessity. Only skilled nursing, occupational and physical therapy, and speech and language pathology services were covered under the policy. However, when the
new TRICARE regions roll out, so do changes to the home health benefit.

Changes in Billing
TRICARE is implementing a prospective payment system patterned after Medicare’s existing plan. Under the new policy, billing will be managed in 60-day episodes of care. For every
60-day episode, home health agencies (HHAs) will receive two payments.
The first payment is a Request for Anticipated Payment (RAP)—60 percent of the total estimated care for the 60-day episode. In order to receive this initial payment, the patient’s primary care physician must establish a treatment plan.
The HHA then completes the Outcome Assessment Information Set (OASIS) using the information in the treatment plan. Those documents must be received and processed by the regional contractor before the RAP will be remitted.

At the end of the 60-day episode of care, the HHA submits an outline of all provided services to the regional contractor. Once that statement is processed, the HHA then receives the final 40 percent of the claim. If the patient requires
additional home health care after the 60 days, the HHA must complete another OASIS and go through the process
again to receive payment.

Changes in Care
Payment processes aren’t all that’s changing with TRICARE’s home health care benefit. The extent of covered services is changing as well. The new home health care plan is designed to provide a more complete array of coverage, including:
  • Physical or occupational therapy
  • Physician-directed medical social services
  • Routine and non-routine medical supplies
  • Services at hospitals when the care involves equipment that cannot be brought into the home
It is important to note that assistance with activities of daily living (washing laundry, cleaning dishes, etc.) 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 considered ancillary and are not his or her primary duties while in the patient’s home.

If you have questions about the new home health care benefit, contact Humana Military at 1-800-444-5445.

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