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.