TRICARE’s home health care benefits are similar to those covered under Medicare. They provide a maximum of 28 hours per week part-time, or 35 hours per week intermittent, skilled nursing care and physical, speech, and occupational therapy. All care must be provided by a participating home health care agency. The 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 care 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.
For more information about home health care, access Chapter 12 of the
TRICARE Reimbursement Manual. For home health care benefits related to the TRICARE ECHO program, refer to Chapter 9, Section 15.1 of the
TRICARE Policy Manual.
Respire Care for Active Duty Service Members
Effective September 18, 2008, TRICARE covers respite care for ADSMs who are homebound as a result of a serious injury or illness incurred while serving on active duty. The benefit is retroactive to January 1, 2008, and provides rest for the primary caregiver caring for an injured or ill ADSM at home.
Respite care is available if the ADSM’s plan of care includes frequent interventions by the primary caregiver. “Frequent” means that more than two interventions are required during the eight-hour period per day that the primary caregiver would normally be sleeping.
Respite benefits are limited to:
- A maximum of 40 respite hours in a calendar week
- No more than five days per calendar week
- No more than eight hours per calendar day
There are no copayments, cost-shares, or dollar maximums.
The respite care must be provided by a TRICARE-authorized home health agency. The care must be approved by the ADSM’s case manager or other approving authority, such as the MMSO or referring MTF. The ADSM is not required to be enrolled in the TRICARE ECHO program to receive this respite benefit.
For additional details on the respite care benefit for ADSMs, refer to Chapter 18, Section 3 and Chapter 18, Addendum C of the
TRICARE Operations Manual.
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