Benefits

Extended Care Health Option benefits include:

• Applied behavior analysis services through the Autism Care Demonstration
• Assistive services (such as those from a qualified interpreter or translator)
• Assistive technology devices
• Durable medical equipment, including adaptation and maintenance equipment
• Expanded in-home medical services through ECHO Home Health Care
• Incontinence supplies (diapers)
  • You may need to file your own claim. Contact your case manager for details.
• Institutional care in private nonprofit, public, and state facilities (may include transport to and from) when a residential environment is required
• Rehabilitative and habilitative services
• Respite care for primary caregivers
• Special education
• Training in the use of special education and assistive technology devices
• Transportation to and from institutions or facilities in certain circumstances

All ECHO benefits must be:

• Authorized in advance, and
• From a TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS (TRICARE doesn’t pay for services provided by family members, trainers, or other individuals who aren't TRICARE-authorized providers.)

Some services may be cost-shared under ECHO or your TRICARE plan. This includes services needed to establish or confirm the severity of a qualifying condition or measure functional loss.

Do you want to change providers? You must get a new benefit authorization from your regional contractor.

Home Health Care

Do you need home health care? ECHO Home Health Care provides medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. skilled services to beneficiaries who:

• Are homeboundTRICARE considers you homebound if you can’t leave your home without a lot of effort.
• Need more than 28–35 hours per week of home health services or respite care

The EHHC benefit is only available in the U.S., Guam, Puerto Rico, and the U.S. Virgin Islands.

Respite Care for primary caregiversAnyone who takes care of the patient at home and helps with daily activities.

Are you a primary caregiver? You may qualify for in-home respite care:

• Up to 16 hours of in-home respite care per month, or
• 40 hours per week (8 hours per day, 5 days a week) if the child qualifies for EHHC

You can’t use them together.

TRICARE covers ECHO respite care even when a primary caregiver or family member isn’t present when care is given.

Respite care is only available in the U.S., Guam, Puerto Rico, and the U.S. Virgin Islands.

Public Funds and Programs

Many communities offer public funds or programs for people with disabilities. You must use these resources first if they’re available and sufficient:

• Training
• Rehabilitation
• Special education
• Assistive technology devices
• Institutional care in private nonprofit, public, and state facilities (may include transport to and from)

What if resources aren’t available? You must include a Public Facility Use Certificate from the proper public official with your ECHO benefits request. They must explain why the resources aren’t available or sufficient.