Home Health Care
Home health care is covered for skilled nursing care and physical, speech and occupational therapy. Providers following the prospective payment system (PPS) may be authorized for a maximum of 28 hours per week part time or 35 hours per week intermittent. Providers following the corporate payment system (CPS) may be authorized for a maximum of 15 hours per week. Care must be provided by a participating home health care agency. The beneficiary must have a plan of care approved by a physician and be confined to the home.
An approval from Health Net Federal Services, LLC (HNFS) is required for all beneficiaries (excluding those with other health insurance). For TRICARE Prime beneficiaries, the initial request must be from the primary care manager (PCM) or a specialist with an HNFS-approved referral on file. A PCM referral or physician’s order is valid for 180 days for active duty services members (ADSMs) and 360 days for non-ADSMs.
HNFS authorizes home health services for an initial 60-day episode of care. If additional home health is required after the initial 60 days, the home health agency can submit a request online. HNFS authorizes additional care in 60-day intervals.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.
Under TRICARE, home health agency providers must follow Medicare guidelines and the TRICARE Reimbursement Manual, Chapter 12 when submitting claims for home health care to HNFS. Learn more on our Home Health Billing page.
There may be separate charges for durable medical equipment, supplies, prosthetics, and specific drugs with applicable copayments and cost shares.