TRICARE pays Medicare-certified Home Health Agencies (HHA) using a PPS modeled on Medicare’s plan. Medicare-certified billing is handled in 60-day care episodes, allowing HHAs to receive two payments of 60 percent and 40 percent, respectively, per 60-day cycle. This two-part payment process is repeated with every new cycle, following the patient’s initial 60 days of home healthcare.
All home health services require prior authorization from Humana Military and must be renewed every 60 days. To receive private duty nursing or additional nursing services/shift nursing, the TRICARE beneficiary may be enrolled in an alternative DHA-approved special program, and a case manager must manage his or her progress.