Tricare echo ppt brief from efmp training conference

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  • Proprietary to HMHS - not to be disclosed.
  • Proprietary to HMHS - not to be disclosed.
  • Proprietary to HMHS - not to be disclosed.
  • Tricare echo ppt brief from efmp training conference

    1. 1. ECHO The E xtended C are Home O ption Program Cindy Wilson, RN, MSN, CCM ECHO/EHHC Case Manager Gulf South Market Office September, 2011
    2. 2. Agenda <ul><li>Eligibility </li></ul><ul><li>Qualifying Condition </li></ul><ul><li>Benefits </li></ul><ul><li>Extended Home Health Care (EHHC) </li></ul><ul><li>Autism Services </li></ul><ul><li>Cost Shares </li></ul><ul><li>Questions </li></ul>Proprietary to Humana Military – not to be disclosed.
    3. 3. Eligibility <ul><li>Active Duty Family Members with a qualifying condition </li></ul><ul><li>Beneficiary must be registered in DEERS </li></ul><ul><li>Family members must be enrolled the Exceptional Family Member Program (EFMP) * </li></ul><ul><ul><ul><ul><li>Sponsor’s branch of service does not provide EFMP </li></ul></ul></ul></ul><ul><ul><ul><ul><li>The dependent resides with the custodial parent who is not the Active Duty sponsor </li></ul></ul></ul></ul><ul><li>Complete the ECHO application with the appropriate regional contractor </li></ul><ul><li>ECHO benefits must be authorized prior to services being rendered. </li></ul><ul><li>Services available under the Basic TRICARE benefit are not covered under the ECHO program. </li></ul>Proprietary to Humana Military – not to be disclosed.
    4. 4. Qualifying Condition <ul><li>Moderate to severe mental retardation </li></ul><ul><li>Serious physical disability </li></ul><ul><li>Extraordinary physical or psychological condition that causes the beneficiary to be homebound </li></ul><ul><li>Multiple disabilities </li></ul><ul><ul><li>May qualify if there are two or more disabilities affecting separate body systems – ex. mild asthma and a cardiac diagnosis </li></ul></ul><ul><li>A diagnosis of a neuromuscular developmental condition </li></ul>Proprietary to Humana Military – not to be disclosed.
    5. 5. Benefits <ul><li>Durable Medical Equipment </li></ul><ul><ul><ul><li>standers, specialized strollers, specialized car seats </li></ul></ul></ul><ul><li>Applied Behavioral Analysis (ABA Therapy) </li></ul><ul><li>Training to use assistive technology devices </li></ul><ul><li>Assistive services </li></ul><ul><ul><ul><li>such as those from a qualified interpreter or translator </li></ul></ul></ul><ul><li>Please note: the maximum benefit is $36,000 per beneficiary per fiscal year (October 1 – September 30). </li></ul><ul><li>Sponsors are responsible for the cost of ECHO benefits that exceed this limit </li></ul>Proprietary to Humana Military – not to be disclosed.
    6. 6. In Home Benefits <ul><li>ECHO Respite Care </li></ul><ul><ul><ul><li>up to 16 hours per month when receiving another ECHO benefit </li></ul></ul></ul><ul><li>EHHC (ECHO Home Health Care) Respite Care </li></ul><ul><ul><ul><li>up to 40 hours per week (eight hours per day, five days per week) </li></ul></ul></ul>Proprietary to Humana Military – not to be disclosed.
    7. 7. Extended Home Health Care (EHHC) <ul><li>Provides medically necessary skilled nursing services for patients -- </li></ul><ul><ul><ul><ul><li>Requires a physician certified plan of care </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Homebound </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Requires frequent skilled interventions </li></ul></ul></ul></ul><ul><ul><li>EHHC annual benefits cap is equivalent to what TRICARE would reimburse if the member was in a skilled nursing facility </li></ul></ul>Proprietary to Humana Military – not to be disclosed.
    8. 8. Autism Services <ul><li>Applied Behavioral Analysis -- </li></ul><ul><ul><li>Board Certified Provider (BCAB) </li></ul></ul><ul><ul><li>TRICARE certified provider </li></ul></ul><ul><ul><li>Offers therapy for Autism Spectrum Disorders </li></ul></ul><ul><li>DoD Enhanced Access to Autism Services Demonstration – </li></ul><ul><ul><li>“ Autism Demo” </li></ul></ul><ul><ul><li>This program allows non-certified educational intervention service providers, i.e. “tutors” to provide autism services </li></ul></ul><ul><ul><li>Allows for increased access to ABA therapy </li></ul></ul>Proprietary to Humana Military – not to be disclosed.
    9. 9. Proprietary to Humana Military – not to be disclosed.
    10. 10. Cost Shares <ul><li>Pay Grade Monthly Cost Share </li></ul><ul><li>E-1 to E-5 $25 </li></ul><ul><li>E-6 $30 </li></ul><ul><li>E-7, O-1 $35 </li></ul><ul><li>E-8, O-2 $40 </li></ul><ul><li>E-9, W-1, W-2, O-3 $45 </li></ul><ul><li>W-3, W-4, O-4 $50 </li></ul><ul><li>W-5, O-5 $65 </li></ul><ul><li>O-6 $75 </li></ul><ul><li>O-7 $100 </li></ul><ul><li>O-8 $150 </li></ul><ul><li>O-9 $200 </li></ul><ul><li>O-10 $250 </li></ul>Proprietary to Humana Military – not to be disclosed.
    11. 11. South Region Contacts <ul><li>Gulf South Market Office ECHO </li></ul><ul><ul><li>866-323-7155 </li></ul></ul><ul><li>Southeast Market Office ECHO </li></ul><ul><ul><li>800-447-6072 </li></ul></ul><ul><li>Southwest Market Office ECHO </li></ul><ul><ul><li>800-447-8808 </li></ul></ul>Proprietary to Humana Military – not to be disclosed.
    12. 12. Proprietary to Humana Military – not to be disclosed.

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