New Extended Care Health Option

A new health-care benefit is available to families of Reservists being recalled on active duty orders: TRICARE Extended Care Health Option (ECHO) is a supplement to TRICARE health to beneficiaries who qualify based on specific mental or physical disabilities* It offers an integrated set of services and supplies beyond the basic TRICARE and replaces TRICARE's Program for Persons with Disabilities (PFPWD).

ECHO is available only to Active duty family members who have qualifying conditions, but if a Reserve Component member is ordered to active duty for more than 30 days, his or her family may qualify.

Qualifying conditions include moderate or severe mental retardation; a serious physical disability; and an extraordinary physical or psychological condition that the beneficiary is homebound. The ECHO benefit can provide a monthly government cost share up to $2,500 per eligible family member, as defined by law.

It will also continue to offer an integrated set of services and supplies that supplement the basic TRICARE program. All ECHO benefits require prior authorization. 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, for beneficiaries whose visual or hearing impairment qualifies them for ECHO benefits.

* Durable equipment, including adaptation and maintenance.

* Expanded in-home medical services through TRICARE ECHO Home Health Care (EHHC)--up to 40 hours per week (eight hours/day, five days/week) if homebound.

* In-home respite care services (16 hours/month when receiving other authorized ECHO benefits).

To be eligible for ECHO, one must register with the regional TRICARE contractor; enroll in the RC member's service branch Exceptional Family Program (EFMP); provide documentation that the RC member is on active duty, and that the condition is qualifying.

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. In addition, health-care services must also be provided by TRICARE-authorized providers, or, in the case of educational services, by state-licensed or authorized providers.

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.

TRICARE eligibility must be reflected in the Defense Enrollment Eligibility Reporting System (DEERS) in order to receive ECHO benefits.

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 before the loss of their eligibility, and the sponsor is responsible for more than one-half the child's support.

TRICARE-eligible family members of a member on active duty (ADFM) may qualify for ECHO benefits past age 21 if:

* Enrolled in an institution of higher learning that offers an associate or higher degree;

* The ADFM is incapable of self-support because of a mental or physical incapacity; and

* The sponsor provides more than one-half of the dependent's support

Facts about the TRICARE ECHO program have been compiled from various TRICARE Management Activity and contractor Web sites.

Compiled by CAPT Marshall Hanson, USNR (Ret.)

COPYRIGHT 2005 Reserve Officers Association of the United States
COPYRIGHT 2005 Gale Group