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 those offered by the basic TRICARE programs (e.g., TRICARE Prime, TPRADFM, TRICARE Standard and TRICARE Extra). Potential ECHO beneficiaries must be ADFMs, have qualifying conditions, and be registered in the Exceptional Family Member Program (EFMP). Each service branch has its own EFMP and enrollment process. Under certain circumstances, this requirement may be waived. To learn more, contact your service branch’s EFMP representative or visit TRICARE's web site. A record of ECHO registration is stored with the beneficiary’s DEERS information.
Conditions qualifying an ADFM for ECHO coverage include, but are not limited to:
- 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 (EFMP)—unless waived in specific situations—and register to be eligible for ECHO benefits. There is no retroactive registration for the ECHO program. Visit the Military Homefront web site for more information about EFMP.
ECHO Provider Responsibilities
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. Refer patients 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. Providers must obtain prior authorization for all ECHO services, and they may be requested to provide medical records or assist beneficiaries with completing EFMP documents. Network and participating non-network providers must submit ECHO claims to PGBA, LLC.
Additionally, providers rendering applied behavior analysis (ABA) must be:
- TRICARE-authorized
- State-licensed to provide ABA services*
- State-certified Applied Behavior Analysts*
Note: Under the DoD Enhanced Access to Autism 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.
*If state licensure or certification is not available, providers must be certified by the Behavior Analyst Certification Board™ as either Board Certified Behavior Analysts or Board Certified Assistant Behavior Analysts. |
