4.0 POLICY
4.1 For
dates before August 9, 2021, beneficiaries registered in ECHO registered
beneficiaries 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 In
order to assureTo ensure the
quality of care for ECHO beneficiaries, all ECHO respite care services
will 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 Program.
Consequently, the EHHC benefit is available only in locations where
there are Medicare or Medicaid certified HHA
s.
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,
must 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 (US), the District of
Columbia, Puerto Rico, the US 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
is responsible for providing 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 will
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 will shall be
based on 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 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 will shall not
be provided to those beneficiaries who are receiving the EHHC benefit
or the EHHC-Respite Care benefit.
5.3 ECHO respite
care will 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
will shall not
be provided in areas where Medicare or Medicaid certified HHAs are
not available.