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TRICARE Policy Manual 6010.60-M, April 1, 2015
Extended Care Health Option (ECHO)
Chapter 9
Section 12.1
Extended Care Health Option (ECHO) Respite Care
Issue Date:  February 14, 2005
Authority:  32 CFR 199.5(c)(7) and (d)(20)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-109, April 27, 2023
2.0  HCPCS Procedure Codes
S9122 - S9124
Respite care is short-term care for a patient to provide rest and change for those who have been caring for the patient at home, usually the patient’s family.
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 HHAs.
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.
4.12  The primary caregiver or another adult does not have to be present when the HHA clinician provides the ECHO respite service for the care to be covered under the ECHO benefit.
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.
6.1  September 1, 2005.
6.2  August 9, 2021, there is no prerequisite required for beneficiaries registered in ECHO to receive other authorized non-respite care during the same month.
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