• Moderate or severe mental retardation
• Serious physical disability
• Extraordinary physical or psychological condition of such complexity that the beneficiary is homebound
• 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 registration must enroll in their service’s Exceptional Family Member Program (unless waived in specific situations) and register for ECHO with Humana Military in order to be eligible for ECHO benefits. There is no retroactive registration for the ECHO program. Prior authorization must be obtained from Humana Military for all ECHO services.
          

ECHO Benefits

ECHO provides coverage for the following products and services:

• Applied behavior analysis (which includes the DoD Enhanced Access to Autism Services Demonstration) and other services that are not available through schools or other local community resources
• Assistive services (e.g., those from a qualified interpreter or translator)
• Durable equipment, including adaptation and maintenance equipment
• 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, Guam, Puerto Rico, and the U.S. Virgin Islands
  • ECHO respite care: Up to 16 hours of care per month when another ECHO service is rendered
  • EHHC respite care: Up to eight hours per day, five days per week (for those who qualify
• Training to use special education and assistive technology devices
• Institutional care when a residential environment is required
• Transportation to and from institutions or facilities in certain limited circumstances

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

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 the 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 these 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 DoD Enhanced Access to Autism Services Demonstration allows non-certified paraprofessional providers or tutors to provide autism-related services (in particular, applied behavior analysis), under the supervision of a TRICARE-authorized certified therapist, to eligible ADFMs in the United States. TRICARE beneficiaries must be registered in ECHO to receive benefits through the DoD Enhanced Access to Autism Services Demonstration. Note: The allowed cost of services provided by the DoD Enhanced Access to Autism Services Demonstration accrues to the ECHO FY government maximum cost-share. Visit the TRICARE ECHO section for details. More information about the DoD Enhanced Access to Autism Services Demonstration is available at TRICARE's Autism Services Demonstration section.

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