ECHOThe Extended Care Home Option

Program

Cindy Wilson, RN, MSN, CCMECHO/EHHC Case ManagerGulf South Market OfficeSeptember, 2011

2 Proprietary to Humana Military – not to be disclosed.

Agenda

Eligibility Qualifying Condition Benefits Extended Home Health Care (EHHC) Autism Services Cost Shares Questions

3 Proprietary to Humana Military – not to be disclosed.

Eligibility

Active Duty Family Members with a qualifying condition

Beneficiary must be registered in DEERS

Family members must be enrolled the Exceptional Family Member Program (EFMP) *

– Sponsor’s branch of service does not provide EFMP– The dependent resides with the custodial parent who is not the Active Duty

sponsor

Complete the ECHO application with the appropriate regional contractor

ECHO benefits must be authorized prior to services being rendered.

Services available under the Basic TRICARE benefit are not covered under the ECHO program.

4 Proprietary to Humana Military – not to be disclosed.

Qualifying Condition

Moderate to severe mental retardation

Serious physical disability

Extraordinary physical or psychological condition that causes the beneficiary to be homebound

Multiple disabilities– May qualify if there are two or more disabilities affecting separate body

systems – ex. mild asthma and a cardiac diagnosis

A diagnosis of a neuromuscular developmental condition

5 Proprietary to Humana Military – not to be disclosed.

Benefits

Durable Medical Equipment – standers, specialized strollers, specialized car seats

Applied Behavioral Analysis (ABA Therapy)

Training to use assistive technology devices

Assistive services– such as those from a qualified interpreter or translator

Please note: the maximum benefit is $36,000 per beneficiary per fiscal year (October 1 – September 30).

Sponsors are responsible for the cost of ECHO benefits that exceed this limit

6

In Home Benefits

ECHO Respite Care– up to 16 hours per month when receiving another ECHO

benefit

EHHC (ECHO Home Health Care) Respite Care– up to 40 hours per week (eight hours per day, five days

per week)

Proprietary to Humana Military – not to be disclosed.

7

Extended Home Health Care (EHHC)

Provides medically necessary skilled nursing services for patients --

– Requires a physician certified plan of care

– Homebound

– Requires frequent skilled interventions

EHHC annual benefits cap is equivalent to what TRICARE would reimburse if the member was in a skilled nursing facility

Proprietary to Humana Military – not to be disclosed.

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Autism Services

Applied Behavioral Analysis --– Board Certified Provider (BCAB) – TRICARE certified provider– Offers therapy for Autism Spectrum Disorders

DoD Enhanced Access to Autism Services Demonstration – – “Autism Demo”

– This program allows non-certified educational intervention service providers, i.e. “tutors” to provide autism services

– Allows for increased access to ABA therapy

Proprietary to Humana Military – not to be disclosed.

9 Proprietary to Humana Military – not to be disclosed.

10 Proprietary to Humana Military – not to be disclosed.

Cost Shares

Pay Grade Monthly Cost Share

E-1 to E-5 $25 E-6 $30 E-7, O-1 $35

E-8, O-2 $40 E-9, W-1, W-2, O-3 $45 W-3, W-4, O-4 $50 W-5, O-5 $65 O-6 $75 O-7 $100 O-8 $150 O-9 $200 O-10 $250

11 Proprietary to Humana Military – not to be disclosed.

South Region Contacts

Gulf South Market Office ECHO– 866-323-7155

Southeast Market Office ECHO– 800-447-6072

Southwest Market Office ECHO– 800-447-8808

12 Proprietary to Humana Military – not to be disclosed.