What Does Tricare ECHO Benefits Provide my Military Dependent?

After your kiddo is enrolled in the Exceptional Family Member Program (EFMP), you can then enroll her into the Extended Care Health Option (ECHO). This is the supplement that provides for a short list of benefits, including getting the necessary ABA service that should be most effective for your child. Every service does their enrollment into EFMP differently, but ECHO benefits are the same across the uniformed services.

Hope this helps!

Mike


You can link to the following on the Tricare Fact Sheet for ECHO by clicking here…

The Extended Care Health Option (ECHO) is a supplemental program to the TRICARE Basic benefit. ECHO provides eligible active duty family members with an additional financial resource for services and supplies designed to help reduce the disabling effects of a beneficiary’s qualifying condition.

ECHO has no enrollment fee, however; you must register for ECHO to receive ECHO benefits. Registration in ECHO requires the beneficiary be enrolled in the Exceptional Family Member Program (EFMP) as provided by the sponsor’s branch of service. There is no enrollment fee for the EFMP.

ECHO Eligibility
ECHO benefits are available to the following dependents with a qualifying condition:

* TRICARE eligible dependents of members of the uniformed services, including members of the National Guard and Reserves activated for more than 30 days;
* Family members eligible for continued TRICARE medical benefits through the Transitional Assistance Management Program (TAMP);
* Children or spouses of former members of the Uniformed Service who were victims of physical or emotional abuse;
* Family members of a deceased active duty sponsor remain eligible for ECHO benefits during the period they are in transitional survivor status.

Qualifying conditions for ECHO include:

* Moderate or severe mental retardation;
* A serious physical disability;
* A physical or psychological condition that causes the beneficiary to be homebound

Children may remain eligible for ECHO benefits beyond the usual TRICARE eligibility age limit (21 or age 23 if enrolled in college full time) provided the sponsor remains on active duty, the child is incapable of self-support because of a mental or physical incapacity that occurs prior to the loss of their eligibility, and the sponsor is responsible for more than one-half the child’s support.

ECHO Coverage
Benefits provided under ECHO may include any of the following:

* Medical and rehabilitative services;
* Training to use assistive technology devices;
* Special education;
* Institutional care when a residential environment is required;
* Transportation under certain circumstances;
* Assistive services, such as those from a qualified interpreter or translator, for beneficiaries whose visual or hearing impairment qualifies them for ECHO benefits;
* Durable equipment, including adaptation and maintenance of beneficiary-owned equipment;
* In-home medical services;
* In-home respite care services
* Beneficiaries who are homebound may qualify for the ECHO Home Health Care (EHHC) benefit in addition to other ECHO benefits.

Coverage Limit and Government/Sponsor Liability

The Government’s limit for the cost of all ECHO benefits combined, excluding the EHHC, is $36,000 per beneficiary, per fiscal year (October 1–September 30).

ECHO-allowable amounts are not subject to a deductible. The cost-share for every month beneficiaries use ECHO benefits is based on the sponsor’s pay grade, as shown in the following table:

ECHO Cost-Share Amounts
Sponsor Pay Grade

Sponsor Cost-Share Amount

E-1 through E-5: $25.00

E-6: $30.00

E-7 and 0-1: $35.00

E-8 and 0-2 $40.00

E-9, WO/WO-1, $45.00
CWO-2, and 0-3:

CWO-3, CWO-4, $50.00
and 0-4:

CWO-5, 0-5: $65.00

O-6: $75.00
O-7: $100.00
O-8: $150.00
O-9: $200.00
O-10: $250.00

For more information on ECHO, visit the TRICARE website at www.tricare.mil/echo, or contact your regional contractor. For more information about EFMP, beneficiaries may visit the Military Homefront Web site at www.militaryhomefront.dod.mil. You may also call TRICARE Regional Offices North (1-877-874-2273); South (1-800-444-5445); West (1-888-874-9378). If you are overseas, click here for country-specific toll-free contact information.

Are Changes To Tricare Benefits For Autism On The Way?

It is such a tough time for the DoD to consider changes to benefits packages for service members right now, but there are legislators right now that are trying anyway. Here is a link to an article of two legislatures who are pushing for autistic benefits for retirees and increasing the cap on benefits.

Rising health care costs are on everyone’s mind right now. Health care is going to, yet again, be front and center during next year presidential campaigns. Health care costs are rising dramatically, and the cost of service to treat the military’s autistic dependents is already high. I wish I had actual figures to know what the cost is for the tens of thousands of dependents receiving services such as ABA and other costly treatments, but I know at $36,0000 annually doing the math is not very difficult.

I want to reiterate, especially as an actively serving officer in the Army, that I am pleased to a large degree with the services that Tricare provides. There certainly is MUCH that can be improved on and there are many shortfalls in the administrative areas of Tricare, EFMP, ECHO, Respite and others. I am thankful and appreciative. BUT, the limits currently set by Tricare just aren’t enough to provide the appropriate amount of private care autistic kids need. Don’t get me wrong $36,000 annually is a lot of money. This figure also appears to be the financial benefit benchmark that is being mirrored in those states whose legislatures are passing autism insurance mandates. I would personnaly like to see the cap increased to provide more costly private services like ABA, but I know that Tricare and the government can’t be wholly responsible for all that care. At least, not under the current confines of IDEA and the problems it creates for military families, and ultimately where responsibility for the growing epidemic called autism belongs. My children belong to me. So, ultimately, responsibility for their care, education and development belongs to me as well. I appreciate the care that Tricare provides for private services for all of my boys. But, I also appreciate that some of the fight resides with us navigating the public education system and IDEA to fight for the services my boys need from them as well. I wrote a series of posts a few months ago about Tricare and autism benefits that you can read here.

I am a supporter of these legislative efforts. More money invested into legitimate, plausible autistic treatment methodologies like ABA into early and intensive treatments will only decrease the long term cost on our ever-increasingly fragile systems of Social Security and Medicaid if intensive and early treatment isn’t provided in the early stage of the life cycle. If the government does not pay more now for early intervention through increased caps in benefits, they will certainly pay more later as those autistic dependents grow and mature and require much more from the Tricare system and then the government.

In advocacy,

Mike

Book Review: “Special Needs Families in the Military: A Resource Guide”

As an Army officer with autistic dependents I was very eager to read the new book “Special Needs Families in the Military: A Resource Guide” by Janelle Hill and Don Philpott after I first saw a preview of it in the Army Times two months ago. This is another book in the military life series by Philpott which helps service members and their families deal with the significant yet often overlooked difficulties unique to military life.
The book focuses more on the broad scope of special needs instead of any single disability. It addresses the programs, systems, specific benefits, legal issues, caregiving & support, education, medical care, insurance, advocacy and coping strategies surrounding special needs families in the military. While it is designed for military families, this book could be just as helpful for any parent who has just learned that their child has a disability and needs special help.
The book begins right from the initial shock that every parent experiences when they learn about their kid’s disorder – the whole, “My kid has what?” question that we ask our pediatrician or specialist conducting those initial screenings. The book follows a linear flow and then embraces the softer, emotional issues that all special needs families have to experience and adapt to. Beginning with chapters focused on “First Steps” and the “Diagnoses”, the book takes you through detailed explanations of all the topics listed above. This book is a MUST READ for those who have just learned about their kid’s disability, but it will also be a blessing for those more schooled on the issues or who are looking to refine or better their ability to advocate for their dependents.
The authors have a very easy to digest style that takes complicated issues like IDEA and other federal laws, proper advocating strategies, navigation of the military health care system Tricare, ECHO and the Autism Demonstration. ALso helpful are the wealth of resource information, both print and online, directing the reader to further dig in to resources available to any given special needs situation. Resources like Wrightslaw, STOMP and a plethora of websites and organizations that can provide some sort of assistance to families in very valuable.
My recommendation is that you get a copy of this book today as a resource as you navigate the pathways of autism and advocate for your child. For military families the book is a MUST HAVE as it will help you understand what is available to you regardless of service branch, rank or disability.

When it comes to reading books in order to self-develop and educate yourself to make you a more effective and productive leader in your field, I think Ben Franklin said it best when he said, “If a man empties his purse into his head, no man can ever take it away from him.” Invest in your mind to make yourself a better and more informed advocate. Your auttie will thank you someday for your dedication in his development!

God bless,

Mike