TRICARE Extended Care Health Option

On September 1, 2005, TRICARE's Extended Care Health Option (ECHO) replaced the existing TRICARE Program for Persons with Disabilities (PFPWD). Beneficiaries who still have authorization approvals for PFPWD can continue on those approvals until the expiration or services are requested and authorized under the ECHO program. The following is a summary of TRICARE's Extended Care Health Option:

TRICARE's Extended Care Health Option

This new program will continue to deliver financial assistance to active duty family members who have a qualifying condition as defined by law. It will also continue to offer an integrated set of services and supplies that supplement the basic TRICARE program options- TRICARE Prime (including TRICARE Prime Remote for Active Duty Family Members), TRICARE Standard or TRICARE Extra.

There are many similarities between PFPWD and ECHO, as well as some differences. Now is a good time for beneficiaries to become familiar with the basic requirements and benefits of TRICARE ECHO.

ECHO Eligibility

ECHO benefits are available with a qualifying condition to an active duty TRICARE eligible child or spouse of:

  1. 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; or
  2. Family members eligible for continued TRICARE medical benefits through the Transitional Assistance Management Program (TAMP).
  3. A former member of a Uniformed Service of the United States when the child or spouse is the victim of physical or emotional abuse.

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 homebound

Recipients may retain their eligibility for ECHO services as long as the sponsor remains on active duty. Even children of sponsors who reach the usual TRICARE eligibility age limit (21 or age 23 if enrolled in college full time) retain their eligibility for ECHO services, as long as the sponsor remains on active duty, the child is incapable of self-support because of a mental or physical incapacity that occurs prior to the loss of their eligibility, and the sponsor is responsible for more than one-half the child's support.

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ECHO Coverage

In addition to coverage received via the primary TRICARE plan, TRICARE ECHO 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, for beneficiaries whose visual or hearing impairment qualifies them for ECHO benefits
  • Durable equipment, including adaptation and maintenance
  • In-home medical services through TRICARE ECHO Extended Home Health Care (EHHC)
  • In-home respite care services (Note: Only one of the following respite care benefits may be used in a calendar month.)
    • ECHO Respite care-16 hours per month when receiving other authorized ECHO benefits
    • EHHC Respite care-up to 40 hours per week (eight hours per day, five days per week) if homebound

Services covered under the basic TRICARE benefit cannot be authorized under the TRICARE ECHO program-those services must be authorized under the TRICARE program option the beneficiary is using (TRICARE Prime, TRICARE Prime Remote, TRICARE Standard, TRICARE Extra).

If a beneficiary's family member has a condition that may qualify for services under TRICARE ECHO, they should contact their regional contractor for assistance.

ECHO Details to Come

Additional information about the new TRICARE ECHO program will be posted on the TRICARE Web site or on the regional contractor's Web sites. Current PFPWD participants will receive letters explaining the change with directions for enrolling family members in the EMFP. For more information on the EFMP, beneficiaries may visit www.militaryonesource.mil/efmp.

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ECHO Resources

TRICARE Policy Manual Online

Go to: manuals.tricare.osd.mil
Click on: TRICARE Policy Manual 6010.54-M (TPM), August 2002
Click on: Browse Entire Manual (PDF File will install)
Click on: Chapter 9 - The Extended Care Health Option

Regional Contractors Area Phone Fax
Health Net Federal Services
1-877-TRICARE
Heartland
(MI, WI, IL, IN, KY, OH, WV, PA area near Pittsburgh)
(800) 977-7910
X 62053
(619) 516-2184
Mid Atlantic (Southern VA, NC) (800) 977-7531 (757) 766-5900
Northeast (ME, VT, NH, MA, RI, NY, CT, NJ, DE, MD, PA area near Philadelphia) (800) 977-7961
X 54103
(916) 353-6221
National Capital (Northern VA, MD, DE, District of Columbia, PA area near Dover) (800) 977-7635 (571) 227-6702
Regional Contractors Area Phone Fax
TRICARE South Region:
Humana Military Healthcare Services
1-800-444-5445
Southeast (Augusta) Market
(SC, FL excluding the panhandle, GA)
(800) 447-6072 (706) 854-8604
Gulfsouth (Biloxi) Market
(FL panhandle, TN, AL, MS, New Orleans area of LA)
(866) 323-7155 (228) 385-5138
Southwest (San Antonio) Market
(TX except for extreme Western El Paso area, OK, AR,
LA except for New Orleans area)
(800) 447-8808 (210) 614-4692
Regional Contractors Area Phone Fax
TRICARE West Region:
TriWest Healthcare Alliance
1-888-TRIWEST
Alaska, Arizona, California,
Colorado, Hawaii, Idaho, Iowa
(except 82 Iowa zip codes that
are in the Rock Island [Illinois]area), Kansas, Minnesota,
Missouri (except the
St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon,
South Dakota, Texas (the southwestern corner, including
El Paso, only) Utah, Washington, and Wyoming.
(602) 644-8124
(866) 876-2384
ext 48124
(866) 269-5758
TRICARE Latin America and Canada Special Needs Coordinator (706) 787-2080 (706) 787-3024

Military One Source
Employee assistance program with help on absolutely anything you can imagine!

Military Home Front
Special needs and Exceptional Family Member Program (EFMP) information

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Coverage Limitations

The ECHO benefit provides an increase over the PFPWD government cost-share limit from $1,000 per month to $2,500 per month, per eligible family member. In addition to other TRICARE ECHO benefits, beneficiaries who are homebound may qualify for extended in-home health care services. The $2,500 cost share does not apply to the EHHC as there is a benefit cap. For additional information on this benefit, contact your regional contractor.

Whereas PFPWD requires recipients to first use public funds and facilities to the extent that they are available and adequate, ECHO has this requirement only for a smaller subset of the ECHO benefits. Under both PFPWD and ECHO, sponsors must pay part of the monthly-authorized expenses for their family members, based on their pay grade.

ECHO Registration

Unlike PFPWD, TRICARE ECHO requires all eligible beneficiaries do the following:

  • Enroll in the Exceptional Family Member Program (EFMP) that is available through their service branch (Army, Navy, Air Force, etc.). For more information about the EFMP, beneficiaries may visit the Military Homefront Website; and
  • Register with their regional contractor to obtain ECHO benefit authorization.

For information on ECHO, visit http://www.tricare.mil/Plans/SpecialPrograms/ECHO.aspx.

For general information about TRICARE, call one of the many toll-free TRICARE information lines found at the TRICARE Contact Us web page.

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