In a recent webinar entitled “TRICARE® Extended Care Health Option (ECHO)” participants were able to gather more information about the supplemental services for active duty family members with qualifying mental and physical disabilities provided through TRICARE® ECHO.
Question: What does it mean when it says that you must use a public facility first, before accessing care?
Advice: The ECHO requires that public facilities be used first for services and items related to training, rehabilitation, special education, assistive technology devices, institutional care in private nonprofit, public, and state institutions and facilities and, if appropriate, transportation to and from such institutions and facilities to the extent that they are available and adequate. The public facility use certification is a written confirmation that the requested Extended Care Health Option (ECHO) services or items are either not available from public facilities or are not adequate to meet the needs of the beneficiary’s qualifying condition. There are some exceptions:
- Services available through state-administered plans for medical assistance under Title XIX of the Social Security Act (Medicaid) are not considered available and adequate facilities for the purpose of the ECHO.
- Services and items available through the ECHO Home Health Care (EHHC) or Respite Care benefits do not require a public facility use certification.
- No public facility use certification is required for medical services and items that are provided under Part C of the Individuals with Disabilities Education Act (IDEA) in accordance with the Individualized Family Service Plan (IFSP) and that are otherwise allowable under the TRICARE Basic Program or the ECHO.
The public facility use certification may be issued by the Military Treatment Facility (MTF) Commander/Enhanced Multi-Service Market (eMSM) Manager or an authorized administrator of the public facility. The contractor will determine that services or items are not available from a specific public facility when the beneficiary provides a written statement that the facility refused to provide the required certification. A case-specific determination of public facility availability is conclusive and is not appealable.
Expert: Richard Hart, Senior Health Policy Analyst, Defense Health Agency, Health Plan Execution of Operations.
For more advice from Mr. Hart about ECHO, watch and listen to the professional development training entitled TRICARE® Extended Care Health Option (ECHO).
The new blog series provides monthly advice from subject matter experts on issues surrounding military caregiving for service providers and families. We take questions and concerns from military helping professionals and families and provide the necessary feedback from credible experts in the field of study. Whether you are a provider or a caregiver, what questions do you have? We want to hear from you.
This MFLN-Military Caregiving concentration blog post was published on August 19, 2016.