2.0 POLICY
2.1 The ECHO
requires that public facilities be used first for services and items
related to training, rehabilitation, special education, assistive
technology devices, institutional care in private nonprofit, public,
and state institutions and facilities and, if appropriate, transportation
to and from such institutions and facilities to the extent that
they are available and adequate.
2.2 Services
available through state-administered plans for medical assistance
under Title XIX of the Social Security Act (Medicaid) are not considered
available and adequate facilities for the purpose of the ECHO.
2.3 Services and items available
through the ECHO Home Health Care (EHHC) or Respite Care benefits
do not require a public facility use certification.
2.4 The public facility use certification
may be issued by the Market/Military Medical Treatment Facility
(MTF) Directors or an authorized administrator of the public facility.
2.5 No public facility use certification
is required for medical services and items that are provided under
Part C of the Individuals with Disabilities Education Act (IDEA)
in accordance with the Individualized Family Service Plan (IFSP)
and that are otherwise allowable under the TRICARE Basic Program
or the ECHO.
2.6 For a beneficiary aged 3 to
21 who is enrolled in an education program, the local public education
agency must certify that the services or items requested through
the ECHO are not included on the beneficiary’s Individualized Education
Program (IEP), or if so, are not adequately available.
2.7 A public facility use certification
is valid until such time as the contractor or the TRICARE Overseas Program
(TOP) contractor determines that a new certification is needed in
order to insure that public facilities are used to the extent available
and adequate.
2.8 The contractor shall determine
that services or items are not available from a specific public
facility when the beneficiary provides a written statement that
the facility refused to provide the required certification.
2.9 A case-specific determination
of public facility availability is conclusive and is not appealable.