TRICARE Extended Care Health Option

TRICARE ECHO: For Your Special Needs

Eligibility

• Autism spectrum disorders*
• Diagnosis of a neuromuscular developmental condition/other condition in an infant/toddler expected to precede a diagnosis of moderate/severe mental retardation or serious physical disability
• Extraordinary physical/psychological condition rendering the beneficiary homebound
• Moderate/severe mental retardation
• Multiple disabilities (may qualify if there are two or more affecting separate body systems)
• Serious physical disability

* Effective March 15, 2008, TRICARE introduced the Department of Defense Enhanced Access to Autism Services Demonstration, which provides a greater range of existing evidence-based services (e.g., Applied Behavior Analysis) for ADFMs diagnosed with autism spectrum disorders. To qualify, ADFMs must be at least 18 months old, enrolled in the Exceptional Family Member Program (EFMP), registered for TRICARE ECHO, and live in the 50 United States or the District of Columbia.
 

ECHO Benefits

• Assistive services (e.g., those from a qualified interpreter or translator)
• Durable equipment, including adaptation and maintenance
• Expanded in-home medical services through TRICARE ECHO Home Health Care (EHHC)
• Medical and rehabilitative services
• In-home respite care services (one benefit per calendar month only)
  • ECHO Respite care—16 hours per month when receiving other authorized ECHO benefits
  • EHHC Respite care—up to 40 hours per week (eight hours per day, five days per week) for those who qualify.
  • Training to use assistive technology devices
  • Institutional care when a residential environment is required
  • Special education ( this does not include tuition for a beneficiary to attend private schools)
  • Transportation under certain circumstances for institutionalized ECHO beneficiaries

How to Use ECHO

• Register with your Humana Military Healthcare Services (Humana Military): Provide documentation that you are an ADFM with a qualifying condition and enrolled in the EFMP. Once registration is completed, your DEERS record is modified to indicate TRICARE ECHO eligibility.
• Use public funds and facilities first: Many communities offer funds or programs for people with disabilities. If adequate public assistance is not available, you must include a Public Facility Use Certification letter from the proper public official explaining why public assistance is unavailable or insufficient with your request for benefits.
• Obtain prior authorization: Humana Military must authorize all TRICARE ECHO benefits in advance.
• Select TRICARE providers: All services, supplies, and equipment must be received from a TRICARE-authorized provider. Beneficiaries enrolled in a TRICARE Prime option who receive TRICARE ECHO benefits must also comply with their program’s requirements (e.g., use a primary care manager for routine care and obtain referrals for specialty care).

Costs

Sponsors must pay part of the monthly expenses for ADFMs to receive authorized ECHO benefits. Cost-shares are based on the sponsor’s pay grade and are separate from your TRICARE program option cost-shares. After you pay the monthly cost-share, TRICARE pays up to $2,500 per calendar month per eligible ADFM for authorized ECHO benefits. Note: ECHO cost-shares do not accrue toward the catastrophic cap.