TRICARE Extended Care Health Option
The TRICARE Extended Care Health Option (ECHO) provides financial assistance to ADFMs who qualify based on specific mental or physical disabilities and offers beneficiaries an integrated set of services and supplies beyond the basic TRICARE programs—TRICARE Prime, TPRADFM, TRICARE Standard, or TRICARE Extra.
Potential ECHO beneficiaries must be ADFMs, have a qualifying condition, and be registered to receive ECHO benefits. A record of ECHO registration is stored with a beneficiary’s DEERS information.
Conditions qualifying an ADFM for TRICARE ECHO coverage include:
- 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
TRICARE providers, especially PCMs, are responsible for managing care for TRICARE beneficiaries. Any TRICARE provider (PCM or specialist) can inform the patient’s sponsor about the ECHO benefit. Beneficiaries should be referred to Humana Military for assistance with eligibility determination and ECHO registration. This ensures that the beneficiary and provider have a complete understanding of the benefit and have taken the necessary steps for efficient claims processing.
Note: Active duty sponsors with family members seeking ECHO registration must enroll in their service’s Exceptional Family Member Program (EFMP) and register for ECHO in order to be eligible for ECHO benefits. There is no retroactive registration into the ECHO program.
Prior authorization must be obtained from Humana Military for all care provided under the ECHO program or providers run the risk of having ECHO claims denied.
ECHO Provider Responsibilities
- Providers may be requested to provide medical records or assist beneficiaries with completing EFMP documents.
- Network and participating providers must submit ECHO claims to WPS.
- A provider rendering applied behavior analysis (ABA) must be a TRICARE-certified provider that meets the following criteria:
- Has a current state license to provide ABA services
- Is certified by the Behavior Analyst Certification Board as either a Board Certified Behavior Analyst or Board Certified Associate Behavior Analyst
Note: Under the DoD Enhanced Access toAutism Services Demonstration, non-certified paraprofessional providers may render certain educational intervention services and ABA under close supervision. For more information, see “DoD Enhanced Access to Autism Services Demonstration” later in this section.
- Providers must obtain prior authorization for all ECHO services.
TRICARE can pay for the “hands on” ABA services when provided by a TRICARE-certified provider. However, TRICARE will not pay for such services when provided by family members, trainers, or other individuals who are not TRICARE-certified providers.
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