4.0 POLICY
4.1 For
dates before August 9, 2021, beneficiaries registered in ECHO 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. Effective
August 9, 2021, there is no prerequisite for beneficiaries registered
in ECHO to receive other authorized non-respite care during the
same month.
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 To
ensure the
quality of care for ECHO beneficiaries, all ECHO respite care services
shall 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,
shall 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
shall provide 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
shall 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 shall be
based upon 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 (FY) ECHO
benefit of $36,000.
4.11 Because
ECHO respite care services are provided by HHAs, the TRICARE
Program 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 shall not
be provided to those beneficiaries who are receiving the EHHC benefit
or the EHHC-Respite Care benefit.
5.3 ECHO
respite care shall 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
shall not be provided
in areas where Medicare or Medicaid certified HHAs are not available.