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 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 (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 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 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.
5.0 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.