2.0 POLICY
2.1 Institutional
care when the severity of the qualifying condition requires protective
custody or training in a residential environment, may be cost-shared
subject to all applicable Extended Care Health Option (ECHO) requirements.
2.2 In
accordance with Title 10, Section 1079(d)(4), United States Code
(USC), institutional care must be provided in private nonprofit,
public and state institutions and facilities.
2.3 The requirements of
paragraph 2.2 not
withstanding, institutional care provided by a for-profit entity
may be allowed only when the care for a specific ECHO beneficiary:
2.3.1 Is contracted for by a public
facility, as defined in
32 CFR 199.2,
as part of a publicly funded long-term inpatient care program; and
2.3.2 Is provided based upon the
ECHO beneficiary’s being eligible for the publicly funded program
which has contracted for the care; and
2.3.3 Is authorized
by the public facility as a part of a publicly funded program; and
2.3.4 Would cause a cost-share liability
in the absence of TRICARE eligibility; and
2.3.5 Produces
an ECHO beneficiary cost-share liability that does not exceed the
maximum charge by the provider to the public facility for the contracted
level of care.
3.0 EXCLUSIONS
3.1 Regardless
of the beneficiary’s condition, care within any type of institution
for the primary purpose of providing custodial, domiciliary, hospice,
or respite care is excluded from the ECHO.
3.2 Institutional
care available under the TRICARE Basic Program is not eligible to
be cost-shared under the ECHO.