1.0 POLICY
1.1 Services
and items cost-shared through the Extended Care Health Option (ECHO)
must be rendered by TRICARE authorized providers.
1.2 ECHO inpatient
care providers: A provider of residential institutional care authorized
under the ECHO must:
1.2.1 Be a not-for-profit organization which primarily
provides services to the disabled, OR
1.2.2 Be a facility operated by
the state or under state contract, AND
1.2.3 Meet all applicable licensing
or certification requirements that are extant in the state, county,
municipality, or other political jurisdiction in which the provider
is located.
1.3 ECHO outpatient care providers.
A provider of ECHO outpatient, ambulatory, or in-home services shall
be:
1.3.1 An authorized provider of services as defined
in
32 CFR 199.6, or
1.3.2 An individual, corporation,
foundation, or public entity that predominantly renders services of
a type uniquely allowable as a ECHO benefit and not otherwise allowable
as a benefit of
32 CFR 199.4,
that meets all applicable licensing or other regulatory requirements
that are extant in the state, county, municipality, or other political
jurisdiction in which the ECHO service is rendered.
1.4 Individual
professional providers authorized by
32 CFR 199.6 for
the Basic Program are also authorized providers for the ECHO. Individual
professional providers who can be authorized only under the ECHO
must meet all applicable licensing and other regulatory requirements
that are extant in that state, county, municipality, or other political
jurisdiction in which the ECHO service is rendered, or, in the absence
of such licensing or regulatory requirements, as determined by the
Director, Defense Health Agency (DHA) or designee.
1.5 ECHO vendor. A provider of an allowable ECHO
item, supply, equipment, orthotic, or device shall be deemed to
be an authorized vendor for the provision of the specific item,
supply, equipment, orthotic, or device when the vendor supplies
such information as the contractor or the TRICARE Overseas Program
(TOP) contractor determines necessary to adjudicate a specific claim.