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.