TRICARE Increases Payments for Beneficiaries with Special Needs

Falls Church, Va. – TRICARE has increased the amount it will pay for certain Extended Care Health Option ECHO benefits. ECHO assists eligible family members of active duty sponsors who are diagnosed with moderate or severe mental retardation, a serious physical disability, or an extraordinary physical or psychological condition.

The total TRICARE cost share for training, rehabilitation, special education, and assistive technology devices was increased to $36,000 per fiscal year. The cap also covers institutional care in private nonprofit, public and state institutions and facilities and, if appropriate, transportation to and from such institutions and facilities. The TRICARE Enhanced Access to Autism Services “Demonstration” is also included.

“This is good news for military families out there with an ECHO-qualified family member,” said Army Maj. Gen. Elder Granger, deputy director of TRICARE Management Activity. “This change will help make services more accessible to our deserving special needs beneficiaries.”

Previously, all ECHO benefits were subject to a government cost-share limit of $2,500 per month.

Some ECHO benefits are still subject to the $2,500 per month cap and ECHO Home Health Care has its own unique reimbursement limits. For more information on ECHO services, costs and limitations go to http://www.tricare.mil/ECHO or contact the appropriate regional managed care support contractor found at http://www.tricare.mil/contactus. Additional details can also be found at the TRICARE blog at http://www.health.mil/tmablog/Article.aspx?ID=470.

The ECHO increase was included in the National Defense Authorization Act for Fiscal Year 2009, which was signed into law on Oct. 14, 2008. As a result, TRICARE urges eligible beneficiaries to submit any claims for their out-of-pocket payments for the identified ECHO services received on or after Oct. 14, 2008 that were previously limited by the $2,500 monthly cap.

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