Extended Care Health Option

The TRICARE Extended Care Health Option (ECHO) provides financial assistance to eligible beneficiaries who qualify based on specific mental or physical disabilities and offers an integrated set of services and supplies not available through the basic TRICARE program. TRICARE ECHO doesn't replace basic TRICARE programs; it supplements the benefits of the TRICARE program option that eligible beneficiaries use.

Eligibility for ECHO

ECHO benefits are only available to active duty family members (including family members of activated National Guard or Reserve members) residing in the continental United States or one of the U.S. territories. Active duty family members must qualify for ECHO through ECHO case managers in each TRICARE region.
ECHO benefits are not available in overseas locations.
The following sections highlight who may qualify for ECHO, the benefits provided and the costs for ECHO services. You also will learn about special requirements and where to go for more information or assistance if you think you or someone in your family may qualify for ECHO.

Who May Qualify
The TRICARE Extended Care Health Option (ECHO) is available only to active duty family members who have a qualifying condition.

Qualifying conditions 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 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
If you or your provider believes a qualifying condition exists, talk to a case manager or with your Exceptional Family Member Program and must be registered for TRICARE ECHO with their regional contractor or TRICARE Area Office. There is no enrollment fee for TRICARE ECHO.

Benefits
For those who qualify, the TRICARE Extended Care Health Option (ECHO) provides benefits not available through the basic TRICARE program. These benefits may include:

Medical and rehabilitative services
Training to use assistive technology devices
Special education
Institutional care when a residential environment is required
Transportation under certain circumstances
Assistive services, such as those from a qualified interpreter or translator
Durable equipment, including adaptation and maintenance
Expanded in-home medical services through TRICARE ECHO Home Health Care
In-home respite care services
TRICARE ECHO Respite care: 16 hours per month when receiving other authorized ECHO benefits
TRICARE ECHO Home Health Respite care: up to 40 hours per week (eight hours per day, five days per week) for those who qualify
Note: Only one of the above respite care benefits can be used in the same calendar month, they cannot be used together.

Costs
You must pay part of the monthly expenses for authorized TRICARE Extended Care Health Option (ECHO) benefits. The monthly cost share is based on the sponsor's pay grade as shown in the chart below.

The monthly cost share is only one fee per sponsor, not per ECHO beneficiary. You only pay the cost share if you used ECHO benefits during that calendar month.

Pay Grade
Monthly Cost share

E-1 to E-5
$25

E-6
$30

E-7, O-1
$35

E-8, O-2
$40

E-9, W-1, W-2, O-3
$45

W-3, W-4, O-4
$50

W-5, O-5
$65

O-6
$75

O-7
$100

O-8
$150

O-9
$200

O-10
$250


After you pay the monthly cost share, TRICARE will pay up to $2,500 per calendar month for each ECHO-registered beneficiary for authorized ECHO benefits (the limit on ECHO Home Health Care benefits is separate, see below). If an ECHO beneficiary's costs exceed $2,500 in a calendar month, you are responsible for paying the additional costs.

Special Requirements
The following are special requirements that active duty family members must meet in order to receive TRICARE Extended Care Health Option (ECHO) benefits:

Enroll in the Exceptional Family Member Program (EFMP)
Although some programs may have a different name, each uniformed services branchArmy, Air Force, Navy, Marine Corps and Coast Guardhas an EFMP. These programs help ensure that you are located in geographical areas where the needs of your family can be met.

Enrollment in the EFMP is mandatory. Once you have identified that you or a family member has special need, you must enroll immediately. Each uniformed services branch has its own EFMP enrollment process. Get more information about EFMP.

Register for TRICARE ECHO
To receive TRICARE ECHO benefits, you must register with your regional contractor or TRICARE Area Office. You will need to show documentation stating that you (the person applying for ECHO benefits) are an active duty family member, that a qualifying condition exists and that you are enrolled in the EFMP. When the registration is complete, your Defense Enrollment Eligibility Reporting System record is modified to indicate eligibility for TRICARE ECHO.

Use Public Funds and Facilities First
Many communities offer public funds or programs for persons with disabilities. You must use these resources first to the extent they are available and adequate for TRICARE ECHO benefits related to:

Training
Rehabilitation
Special education
Assistive technology devices
Institutional care in private nonprofit, public and state institutions/facilities and, if appropriate, transportation to and from such institutions and facilities
If adequate public assistance is not available, you must include a letter from the proper public official explaining why public assistance is unavailable or insufficient with your request for TRICARE ECHO benefits. This is called a Public Facility Use Certificate.

Have Benefits Authorized in Advance
Your regional contractor or TRICARE Area Office must authorize all benefits under TRICARE ECHO in advance. Most providers will file claims on your behalf. If you are required to file a claim for ECHO-authorized care, you or your sponsor should use Patient's Request for Medical Payment form (DD Form 2642). Include a copy of the authorization with the claim form.

Seek Care from TRICARE Providers
All services, supplies and equipment must be received from a TRICARE-authorized provider. If you want to change health care providers while receiving TRICARE ECHO benefits, you must obtain a new benefit authorization from your regional contractor or TRICARE Area Office.

ECHO Home Health Care
ECHO Home Health Care (EHHC) provides medically necessary skilled services to those ECHO beneficiaries who are homebound and generally require more than 28 to 35 hours per week of home health services or respite care. The patient's primary care manager or attending physician will determine if the patient is eligible for EHHC services and will develop a plan of care which will be reviewed by the physician, case manager and/or regional contractor every 90 days or when there is a change in the patient's condition.

In general, beneficiaries are considered homebound if their conditions are such that they can't leave their homes without considerable and taxing effort. If beneficiaries leave their homes regularly for therapeutic, psychosocial or medical treatment or to attend an accredited, certified adult daycare program, this will not disqualify them from being considered for EHHC eligibility.

Eligibility
A TRICARE beneficiary who is registered in ECHO is eligible to receive EHHC when he or she:

Physically resides in the 50 United States, District of Columbia, Puerto Rico, the U.S. Virgin Islands or Guam
Is homebound
Requires medically necessary skilled services beyond the level of coverage provided by the TRICARE Home Health Care Prospective Payment System
Requires frequent interventions that are normally provided by his or her primary caregiver(s)
Has a case manager who periodically assesses needs and required services
Has a physician-certified plan of care that details services provided
Benefits
The following services may be covered when provided by a TRICARE-authorized home health agency in the beneficiary's home:

Skilled nursing care from a registered nurse, or by a licensed or vocational nurse under direct supervision of a registered nurse
Services provided by a home health aid under direct supervision of a registered nurse
Physical therapy, occupational therapy and speech-language pathology services
Medical social services under the direction of a physician
Teaching and training activities
Medical supplies
EHHC Respite Care
Respite care is designed to provide temporary relief or rest for the primary caregiver of a homebound beneficiary who requires frequent care. Beneficiaries eligible for EHHC Respite Care may receive 8 hours of respite care, 5 days per calendar week. This benefit is different from the 16 hours of respite care available through ECHO and the two cannot be used consecutively. EHHC respite care cannot be used for babysitting/child care services, sibling-care, employment, deployment or pursuing education. The hours are not accumulative.

Benefit Cap
Coverage for the EHHC benefit is capped on an annual basis. The cap is equivalent to what TRICARE would pay if the beneficiary resided in a skilled nursing facility. This amount is based on the beneficiary's geographic location.


For more information, and a printable brochure on Tricare ECHO, click on the link below:

http://www.tricare.mil/mybenefit/Download/...chure_11.06.pdf