Tricare Echo Program and ABA
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I'm still navigating the military healthcare system to find services for my son. I'm wondering if any of you have received ABA services through TriCare or the ECHO program? If so, can you share your experience with me? How lengthy was the process? Did you have to BEG for the services? What did they require from educators/physicians? Any insight is very much appreciated. Once you are determined to be eligible for the program, it may be fairly difficult to find ABA providers depending on your location. Some of the ease in accessing services appears to depend on the competency of your case manager. Can you update and advise on whether you had success accessing services? Have you been approved for the ECHO program? If so talk to your case manager about the Autism Demonstration Project. Under that the ECHO program will now allow funds to be paid for tutors - meaning more hours of ABA! If you haven't been approved yet I will tell you my son was enrolled within weeks - no time at all and he would have been sooner if it wasn't for something I missed and didn't fax over! Good luck! My son was not approved for the ECHO program. I am working and do not have the denial paperwork at hand but will fill you in when I do. The declination still steams me as I struggle for basic coverages within the regular insurance system. My son has sensory issues which led to a dental problem. I took him to the emergency room on a Saturday at his dentist's urging but cannot get TriCare or United Concordia to pay the claim. He was treated with an antibiotic and pain meds ... no dental procedures were done but because the ER physician coded the visit "dental", TriCare will not pay. United Concordia will not pay because it was "clearly medical, not dental". GRRRRR!!!! I'm not sure if this will make complete sense, but here goes....when youapply for the ECHO program, for some reason I have no idea why, Tricare WILL send you a denial letter. My doc says they ALWAYS do! Have you been denied by Tricare or ECHO? Call ECHO directly if the denial letter came from Tricare. They needs your sons doc to send in an Eval stating the DX. You need to send them his IEP. Then you'll go through an approval process (hopefully). I'm not sure what ECHO's policies are as far as who they approve. When I talked with them about getting my son in the program it sounded as if he needed a dx of classic autism - which he has. I'm not 100% sure that's the way it is though. I'm sorry you're having such a hard time with insurance! Hopefully this helped some! ((hugs)) Yes it is, I'm not an expert on all aspects of the program (how to sign up, etc.) but I am a provider once you get there. Believe it stands for extended care health options and is meant to provide coverage beyond typical tricare services. for example, ECHO covers applied behavior analysis services for children diagnosed with autism spectrum disorders. its not a perfect system but it is one of the best resources if you qualify. for example, it covers $2,500.00 per month ($30,000.00 per year) for ABA services. That goes a long way toward covering needed services. search ECHO in other threads here - it looks like there are others that have some excellent suggestions on the details. Here's something interesting that I found: TRICARE Extended Care Health Option ECHO, a supplemental TRICARE program, provides financial assistance to eligible active duty family members (ADFMs) who have a qualifying mental or physical disability. The program offers services and supplies beyond the basic TRICARE benefits covered in Prime, Extra and Standard. The ECHO benefit also provides a monthly government cost share of $2,500 per eligible family member, a $1,500 increase over the Program for Persons with Disabilities' (PFPWD) cost share. Additionally, some beneficiaries may qualify for ECHO Home Health Care (EHHC). EHHC provides medically-necessary skilled services to eligible homebound beneficiaries. ADFMs currently covered by the Custodial Care Transition Policy (CCTP) upon ECHO implementation Sept. 1, 2005, and who need skilled medical services that exceed the levels offered through EHHC, will continue to receive coverage under CCTP, as long as it is necessary. Annual assessments will be conducted to ensure beneficiaries are receiving the care and services needed.
Eligibility TRICARE ECHO is only available to ADFMs who are enrolled in the Exceptional Family Member Program (EFMP), registered in ECHO and have a qualifying condition: § Moderate or severe mental retardation; § A serious physical disability; or § An extraordinary physical or psychological condition of such complexity that the beneficiary is homebound. Multiple disabilities involving two or more separate body systems may result in a qualifying condition determination. The beneficiary's attending physician or primary care manager (PCM) is responsible for determining if services are needed beyond those offered through basic TRICARE programs. PCMs must also provide medical documentation to support the determination that the beneficiary has a qualifying condition. Additionally, health care services must also be provided by TRICARE-authorized providers, or, in the case of educational services, by state-licensed or authorized providers. TRICARE-eligible dependants of active duty service members may qualify for ECHO benefits past age 21 if: § Enrolled in an institution of higher learning that offers an associate or higher degree; § The dependant is incapable of self support because of a mental or physical incapacity; or § The sponsor provides more than one-half of the dependant's support TRICARE eligibility must be reflected in the Defense Enrollment Eligibility Reporting System (DEERS) in order to continue receiving ECHO benefits.
Exceptional Family Member Program Enrollment It is important for sponsors to enroll in their Exceptional Family Member Program (EFMP) to ensure their family members can receive the best care possible at their existing and future duty assignments. By enrolling in the EFMP, active duty service members will be assigned to installations that can support a family member with special medical and/or educational needs unless they choose to take an assignment that may not be able to provide the medical care needed. Eligible beneficiaries must complete a DD form 2792 (medical summary) and/or DD form 2792-1 (special education/early intervention summary) and submit the form(s) to their exceptional family member coordinator to enroll in their Service-specific EFMP. Once enrolled in EFMP, sponsors do not have to re-enroll if their duty assignment changes. Their EFMP status will automatically transfer to the new region.
ECHO Registration Sponsors must provide evidence of enrollment in EFMP to their regional contractor to be registered in ECHO. To determine if an ADFM qualifies for ECHO, beneficiaries should contact their TRICARE regional contractor or their military treatment facility's (MTF) special needs coordinator. TRICARE ECHO requires all eligible beneficiaries to enroll in the EFMP of their sponsor's military service, and to register with their regional contractor or Overseas TRICARE Area Office (TAO) to obtain ECHO benefit authorization. Family members who accompany their sponsor to a new duty assignment are still registered in ECHO. Upon arrival to the new assignment, ECHO families should contact their regional contractor to discuss case management and coordination of care. Eligible beneficiaries may be granted provisional ECHO status for a period of no more than 90 days until they are enrolled in EFMP and registered with their regional contractor or Overseas TAO. Upon completion of the ECHO registration process, the provisional status will be converted to permanent. If the beneficiary is found ineligible for ECHO, the provisional status will be terminated and all ECHO benefits will end. Beneficiaries who received ECHO benefits during their provisional status will not have to repay the government for services received. Once registered in ECHO, sponsors do not have to re-register at the new duty assignment. Their ECHO status will automatically transfer to the new region.
Benefits The following benefits may be offered through ECHO: § Medical and rehabilitative services § Training to use assistive technology devices § Special education § Institutional care when a residential environment is required § Transportation under certain circumstances § 6 hours of in-home respite care services per month if the beneficiary is receiving another ECHO benefit
Cost Shares Sponsors will pay part of the monthly authorized ECHO expenses for their family members based on their pay grade.
After the monthly cost share is paid, TRICARE will pay up to $2,500 per month for authorized ECHO benefits, except for the EHHC benefit. If the cost exceeds $2,500 in any month, the sponsor is responsible for the additional costs. If two or more persons with the same sponsor receive benefits under ECHO, the sponsor will pay only one monthly cost share and TRICARE will pay up to $2,500 for each ECHO-eligible beneficiary, except for the EHHC benefit. If the costs exceed $2,500 for any individual in any month, the sponsor is responsible for additional costs.
Special Requirements Beneficiaries must use public funds or programs first to the extent they are available and adequate for ECHO benefits related to training, rehabilitation, special education, assistive technology devices and institutional care in private, non-profit, public, and state institutions or other medical facilities and if appropriate, transportation to and from such institutions and facilities.
Resources For more information about ECHO benefits, eligibility requirements, updates and EFMP registration, beneficiaries may visit www.tricare.osd.mil/echo or call their regional contractor: North Region (1-877-874-2293); South Region (1-800-444-5445); or West Region (1-800-874-9378). Overseas beneficiaries may call 1-888-777-8343 |
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