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.