TRICARE Extended Care Health Option Details
ECHO Benefits
Coverage through the TRICARE basic programs may not be sufficient for those eligible beneficiaries with qualifying needs. TRICARE ECHO provides the following additional benefits for these beneficiaries.
ECHO Basic Benefits
- Medical, habilitative, and rehabilitative services
- Training to use assistive technology devices
- Special education, including ABA therapy and Educational Interventions for Autism Spectrum Disorders (EIA) services through the Enhanced Access to Autism Services Demonstration
- Institutional care when a residential environment is required
- Transportation under certain limited circumstances (i.e., to receive an authorized ECHO benefit) and coverage for a medical attendant when needed to ensure safe transport of the beneficiary
- Assistive services, when needed to receive an authorized ECHO benefit, such as those from a qualified interpreter or translator
- Durable equipment (e.g., electrical or mechanical lifting device for a wheelchair-bound beneficiary)
- ECHO respite care—16 hours per month to provide relief for primary caregivers*
ECHO Home Health Care Benefits
- Expanded respite care and in-home medically necessary skilled services through TRICARE ECHO Home Health Care (EHHC)
- EHHC respite care—up to eight hours per day, five days per week to provide relief for the primary caregivers to allow them rest/sleep*
- EHHC provides homebound beneficiaries requiring skilled, extended in-home health care services that are:
- Not limited to part-time or intermittent
- Capped by cost, not by hours (using the skilled nursing facility reimbursement rate)
For more information regarding the EHHC, refer to Chapter 9, Section 15.1 of the TRICARE Policy Manual.
* ECHO respite care benefits can only be used in a month when another ECHO benefit is being received. Both respite benefits (ECHO respite and EHHC respite) cannot be used in the same calendar month. The respite benefits cannot be used for siblings, employment, deployment, or pursuing education, and they are not accumulative (i.e., unused hours cannot be carried over into the next month).
ECHO Costs
Effective October 14, 2008, the government’s maximum cost-share for certain ECHO services is $36,000 per fiscal year. Services included in this change are:
- Assistive technology devices
- Institutional care
- Transportation to and from institutions or facilities
- Rehabilitation
- Special education (which can include ABA)
- Training
An ECHO maximum monthly cost-share of $2,500 applies to services provided under Sections 6.1, 7.1 (excluding rehabilitation), 12.1, 13.1, and 14.1 of the TRICARE Policy Manual, and accrues to the fiscal year maximum cost-share:
- Assistive services
- Diagnostic services
- Durable equipment
- ECHO respite care
- Treatment (excluding rehabilitation)
Maximum cost-share limits under the ECHO program are per beneficiary, regardless of the number of dependents with the same sponsor receiving ECHO benefits in that period.
Costs for EHHC services do not accrue to the monthly or fiscal year government maximum cost-shares.
Cost-shares under ECHO are in addition to those incurred for services provided under the basic TRICARE benefit (e.g., TRICARE Prime, TPRADFM, TRICARE Standard, TRICARE Extra).
Note: ECHO sponsor/beneficiary cost-shares do not accrue toward the catastrophic cap.
Prior Authorizations
Providers have the responsibility to contact the market case manager to obtain an authorization before providing ECHO services. An ECHO case manager can be reached by calling the applicable market toll-free number:
- Florida (excluding the panhandle), Georgia, and South Carolina, call 1-800-447-6072
- Alabama, Florida panhandle, Louisiana (east of the Mississippi River), Mississippi, and Tennessee, call 1-866-323-7155
- Arkansas, Louisiana (west of the Mississippi River), Oklahoma, and Texas (excluding the El Paso area), call 1-800-447-8808
Claims
See the Claims Processing and Billing Information section of this handbook for details on filing ECHO claims.
For More Information
For more information regarding TRICARE ECHO, refer to Chapter 9 of the TRICARE Policy Manual. Refer to the resources listed below for additional information and assistance:
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