• Moderate or severe mental retardation
• A serious physical disability
• An extraordinary physical or psychological condition of such complexity that the beneficiary is homebound
• A diagnosis of a neuromuscular developmental condition or other condition in an infant or toddler (under age 3) that is expected to precede a diagnosis of moderate or severe mental retardation or a serious physical disability
• Multiple disabilities, which may qualify if there are two or more disabilities affecting separate body systems

Note: Active duty sponsors with family members seeking ECHO benefits must enroll in their service’s Exceptional Family Member Program (unless waived in specific situations) and register for ECHO in order to be eligible. There is no retroactive registration for the ECHO program. All ECHO services require prior authorization from Humana Military.
      

ECHO Benefits

ECHO provides coverage for the following products and services:

• Applied Behavioral Analysis Therapy (which includes the Autism Services Demonstration) and other types of special education (which can include applied behavioral analysis but excludes education for which the school system is responsible) that are not available through local community resources
• 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)
  Rehabilitative services
• Respite care (during any month when at least one other ECHO benefit is received and limited to the 50 United States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam.
• ECHO respite care: Up to 16 hours of care
• EHHC respite care: Up to eight hours per day, five days per week (for those who qualify)
• Training for special education and use of assistive technology devices
• Institutional care when a residential environment is required
• Transportation under certain limited circumstances

For information on the ECHO program, including costs and maximum cost-shares (i.e., ECHO cap), visit TRICARE's ECHO Portal.
     

DoD Enhanced Access to Autism Services Demonstration

The DoD Enhanced Access to Autism Services Demonstration was established to test the feasibility and advisability of permitting TRICARE reimbursement for educational interventions for autism spectrum disorders delivered by paraprofessional providers known as tutors. This demonstration provides information that will enable DoD to determine the following:

• If there is increased access to these services
• If the services are reaching those most likely to benefit from them
• If the quality of those services is meeting the appropriate standard of care currently accepted by the professional community of providers, including the Behavior Analyst Certification Board®
• That state licensure and certification requirements, where applicable, are being met

The Enhanced Access to Autism Services Demonstration allows non-certified paraprofessional providers or tutors to provide autism-related services (in particular, applied behavioral analysis), under the supervision of a TRICARE-authorized certified therapist, to military family members in the United States. You must be registered in ECHO to receive Autism Services Demonstration services. 

Note: The allowed cost of services provided by the Enhanced Access to Autism Services Demonstration accrues to the ECHO fiscal year government maximum cost-share. For more information, visit the TRICARE ECHO Portal.

More information about the Enhanced Access to Autism Services Demonstration is available at TRICARE's web site.

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