2.0 POLICY
2.1 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.
2.2 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.
2.3 Services
and items available through the ECHO Home Health Care (EHHC) or
Respite Care benefits do not require a public facility use certification.
2.4 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.
2.5 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.
2.6 For a beneficiary aged 3 to
21 who is enrolled in an education program, the local public education
agency must certify that the services or items requested through
the ECHO are not included on the beneficiary’s Individualized Education
Program (IEP), or if so, are not adequately available.
2.7 A public
facility use certification is valid until such time as the contractor
or the TRICARE Overseas Program (TOP) contractor determines that
a new certification is necessary in order to insure that public
facilities are used to the extent available and adequate.
2.8 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.
2.9 A case-specific
determination of public facility availability is conclusive and
is not appealable.