EFMP FAMILIES

The Tricare ECHO Program offers supplemental services to Active Duty Family Members who meet the following criteria:

​

- Must have a qualifying mental, developmental, or physical disability

- Must be enrolled in EFMP and register for ECHO with their regional contractor to be eligible for ECHO benefits (regional contractor contact info).

- Must be pre-authorized by your regional contractor before obtaining ECHO services

This is not child care or respite care. This care is subject to co-payments, and all ECHO benefits combined cannot exceed $36,000 per year 

- Must be homebound

- The child in consideration must require skilled services beyond the level of coverage that TRICARE Home Health Care Prospective Payment System (THHCPPS) provides. 

- Require frequent interventions that their primary caregiver normally provides

- Have a case manager who periodically assesses their needs and required services

- Have a physician-certified plan of care that details the services that are to be provided

- Must have a referral or prescription from your primary care manager

- Your physician, case manager, and regional contractor must review your plan every three months or if there is a change in condition

If the EHHC care is offered in the family's home, you could qualify for Respite Care to receive temporary relief for up to 8 hours per day and 5 days per week.

If you are the primary caregiver of a beneficiary, you may qualify for EHHC Respite Care up to 8 hours per day, up to 5 days per week. This is not child care; siblings are not eligible, and you cannot work or use this time to further your education. 

Requirements:

- Must be homebound and require frequent care

- Cannot be used in the same month as ECHO’s respite care which is capped at 16 hours per month

ECHO Respite Care is limited to 16 hours a month in which any other ECHO-authorized benefit is being used

Eligibility requirements include the following (information can be found at this link under Related Downloads):

- Must be an Active Duty Family Enrolled in Tricare Prime, TRICARE Select, US Family Health Plan, TRICARE Overseas Program (TOP), or TOP Select. This care is also available to National Guard and Reserve members who have been activated for more than 30 days Family members may be eligible under the Transitional Assistance Management Program, family members of former service members who were victims of abuse, or family members of a deceased active duty sponsor 

 

While this is not the comprehensive list of eligible conditions, they may include:

- Autism spectrum disorder 

- Moderate or severe intellectual disability 

- Serious physical disability 

- Extraordinary physical or psychological condition of such complexity that the beneficiary is homebound 

- Diagnosis of a neuromuscular developmental condition or other condition in an infant or toddler (under age 3) that is expected to precede a diagnosis of moderate or severe intellectual disability or a serious physical disability 

- Multiple disabilities, which may qualify if there are two or more disabilities affecting separate body systems