TRICARE: ECHO Enhanced Care Health Option

 

TRICARE ECHO provides financial assistance to beneficiaries who qualify based on specific mental or physical disabilities.  This program supplements the benefits of the TRICARE option you are using Prime, Extra or Standard.

Congress established PFPWD for active duty family member with a qualifying disability. ECHO provides another way to receive services, equipment, and supplies necessary for diagnosis, treatment, habilitation, and rehabilitation, as well as providing financial assistance. This benefit is only for active duty families.

 

Who Qualifies for ECHO?

A member of one of the Uniformed Services of the United States, including members of the Reserve Component activated for a period of more than 30 days.

Family members eligible for continued TRICARE medical benefits through the Transitional Assistance Management Program (TAMP).

The following are qualifying conditions under both PFPWD and ECHO:

  • Moderate or severe mental retardation
  • A serious physical disability

Additionally, the law added a basis for an additional qualifying condition:

  • An extraordinary physical or psychological condition of such complexity that the beneficiary is home bound

 

What Can ECHO Offer My Family Member?

 The maximum allowable monthly benefit of the program is $2,500. This can be used in the following ways:

For medical and rehabilitative services

  • For training to use assistive technology devices
  • For institutional care when a residential environment is required
  • For assistive services – interpreters
  • Durable medical equipment including adaptation and maintenance
  • Expanded in-home medical services through TRICARE ECHO Home Health Care (EHHC)
    • In-home respite care – 16 hours per month when receiving other ECHO benefits
    • ECHO EHHC respite up to 40 hours per week if homebound

Example: The cost of equipment that is determined medically necessary and prescribed by a physician such as, a wheelchair/speech and communication devices/Orthotics etc. can be divided and paid through ECHO over a period of months.

 Note: ECHO provides benefits that are NOT available through the basic TRICARE program.

 

 Advantages of ECHO:

  • The family may determine and select the most cost-beneficial program through which to receive services.
  • ECHO also shares in the cost of some additional benefits not available through TRICARE, some of which are:
    • Equipment that does not qualify as Durable Medical Equipment (DME)
    • Unique adaptive training
    • Special education/instruction program and tutor
    • Adjunct services, such as a reader for a blind beneficiary
    • Medical attendant during transport to receive ECHO services
    • Transportation

 

Points To Remember About ECHO:

  • Cost is rank associated between $25 to $250 per month
  • Families must be enrolled in the Exceptional Family Member Program (EFMP)
  • To the extent adequate and available, services from other public resources must be utilized first.
    • Non school age individuals looking to receive benefits from ECHO must provide a letter from a public official explaining why public assistance is insufficient or not available
    • For school age children (3–22) the parent must provide a copy of the IEP
  • In-home nursing care
  • Home Health Care
    • Limited to the amount TRICARE would pay if the ECHO eligible person resided in a skilled nursing facility (SNF)
  • Coverage One Person
    • $2,500 per month for authorized ECHO benefits
    • Costs exceeding $2,500 will be the responsibility of the family
  • Coverage – Two or more ECHO eligible persons
    • Only one payment of the monthly cost-share
    • Each ECHO beneficiary will receive $2,500 per month for authorized ECHO benefits
    • Costs exceeding $2,500 will be the responsibility of the family
  • National Guard and Reserve sector have a complicated path:
    • Reservists called to active duty for more than 30 consecutive days can become eligible for care in the military health system and must be enrolled in EFMP
    • Each remains eligible during their transitional health care, but will cease to be eligible when their Transition Assistance Medical Program (TAMP) benefits end

(NOTE: The one exception to this is the Individuals with Disabilities Education Act (IDEA), which, in 1997, was amended to clarify that the Department of Defense health care system pay first for otherwise allowable Part C services. This applies to children in the 0-3 age group only.)

“Working Together with Military Families of Individuals with DisAbilities!”

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