4.0 POLICY
4.1 ECHO registered
beneficiaries are eligible to receive a maximum of 16 hours of respite
care in any calendar month in which they also receive any other
ECHO authorized benefit other than the ECHO Home Health Care (EHHC)
benefit.
4.2 Respite
care consists of providing skilled and non-skilled services to a
beneficiary such that in the absence of the primary caregiver, management
of the beneficiary’s ECHO qualifying condition and safety are provided.
4.3 Respite
care services are provided exclusively to the ECHO beneficiary.
4.4 In
order to assure the quality of care for ECHO beneficiaries, all
ECHO respite care services will be provided only by Medicare or
Medicaid certified Home Health Agencies (HHAs) who have in effect
at the time of services a valid agreement to participate in the
TRICARE program. Consequently, the EHHC benefit is available only
in locations where there are Medicare or Medicaid certified HHA.
Note: HHAs for which Medicare or Medicaid certification
is not available due to the specialized categories of individuals
they serve, for example, individuals that are under the age of 18
or who are receiving maternity care, must meet the qualifying conditions
for corporate services provider status as specified in
Chapter 11, Section 12.1.
4.5 Currently
the ECHO respite benefit is limited to the 50 United States, the
District of Columbia, Puerto Rico, the U.S. Virgin Islands, and
Guam.
4.6 HHAs are not required to use the comprehensive
Outcome and Assessment Information Set (OASIS) when determining
the services to be provided to a beneficiary under this policy.
4.7 For the
purpose of ECHO respite care, beneficiaries are not required to
have a written plan of care. However, at the time respite care is
requested, the ECHO beneficiary’s sponsor or designee is responsible
for providing the contractor and the HHA with all information necessary
to assure that respite care services are provided in accordance
with
paragraph 4.2.
4.8 HHAs will use procedure codes
indicated in
paragraphs 1.0 and
2.0, to bill for benefits
under this issuance.
4.9 Reimbursement to HHAs for
ECHO respite care will be based on the allowable charge or rates negotiated
by the contractor.
4.10 The amount of the Government’s
cost for respite care received in any month accrues to the maximum
fiscal year ECHO benefit of $36,000.
4.11 Because ECHO respite care
services are provided by HHAs, the TRICARE exclusion at
32 CFR 199.5(d)(10) does not apply. That is,
beneficiaries seeking ECHO respite care are not required to show that
such services are paid for, or eligible for payment, either directly
or indirectly, by a public facility, as defined in
32 CFR 199.2, or otherwise by Federal, State,
or local Government sources.
5.0 EXCLUSIONS
5.1 Baby-sitting
or child care services for other family members or visitors is excluded.
5.2 ECHO respite
care will not be provided to those beneficiaries who are receiving
the EHHC benefit or the EHHC-Respite Care benefit.
5.3 ECHO respite
care will not be provided to cover absences of the primary caregiver(s)
due to deployment, training, employment, seeking employment, or
pursuing education.
5.4 Except as provided in
paragraph 4.4,
ECHO respite care will not be provided in areas where Medicare or
Medicaid certified HHAs are not available.