Retroactive to January 1, 2020, TRICARE manuals now include a Patient-Driven Groupings Model (PDGM) for Home Health Agency (HHA) reimbursement. Humana Military will release PDGM-reimbursed HHA claims with dates of service on or after January 1 as soon as system changes are implemented.
TRICARE’s PDGM reimbursement model closely follows Medicare’s PDGM*.
*Unlike Medicare, TRICARE requires a Treatment Authorization Code (TAC).
**Authorizations for home health services, OASIS assessments and updates to patient care plans remain on a 60-day period of care.
Except for low utilization HHAs, providers must submit an initial claim, also called a Request for Anticipated Payment (RAP), and a final claim. Providers must bill in non-overlapping 30-day periods of care.
Medicare updates rates annually on a calendar year basis.
Note: This guidance does not apply to home health services provided to Active Duty Family Members (ADFM) under the Extended Care Health Option (ECHO).