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 (US), the District of
Columbia, Puerto Rico, the US 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.