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 is required to adjudicate a specific
claim.