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.