1. The ECHO Program and ABA for Military Families: Essential Information for Parent Centers
Hi! You are about to view a short e-learning module about the second and third of three important benefit programs for military families who have children with disabilities. The three programs are TRICARE, TRICARE’s Extended Care Health Option, or ECHO, and Applied Behavior Analysis or ABA therapy, also through TRICARE. This module is an overview of ECHO and ABA.

2. Objectives
Learn about two programs that provide services to military families who have children with disabilities
Understand how these services do, and do not, interact with a child’s services under IDEA
Find out how and where to refer families for these services
Get resources to share with families
By the end of this e-learning module, you’ll have found out why it’s important to know about these military benefits for families you help. You will understand who what benefits are available, who is eligible, and why military families get confused between these benefits and school services under IDEA.
We’ve included a slide with links to our full articles and parent handouts on each program.
At the end, you have a chance to take a short quiz. The quiz is designed to help you remember what you learned from the slides, and let you know if you missed something or misunderstood something. You can take the quiz and view the powerpoint as many times as you wish. If you want to use this powerpoint as part of your professional development, *******[instructions for getting a certificate of successful completion]

3. What is ECHO? Who provides this benefit?
The Extended Care Health Option (ECHO) is provided through TRICARE, which is part of the Department of Defense’s health care system.
It supplements other TRICARE benefits
Planned to provide services and supports similar to those available through some Medicaid Home- and Community-Based Waivers.
TRICARE is the military healthcare program. It covers active duty and retired service members and their families. It also covers National Guard and Reserve service members and families when they are called up for federal duty.
It provides healthcare for members and families of the Commissioned Corps of the US Public Health Service and the National Oceanic and Atmospheric Association, even though they are not military.
TRICARE isn’t health insurance—it looks like it, it acts like it—but it’s an entitlement program established by Congress, and all changes to the program need to be made by Congress.
ECHO was originally designed to help military families who did not stay in any one state long enough to get access to Medicaid Home and Community Based Waiver benefits. Military families can and do get Medicaid, but their high mobility creates big challenges for access.

4. Who provides it? What is ABA Therapy?
“Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree”
(Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991)
-offered through TRICARE.
For individuals with an Autism Spectrum diagnosis, ABA is used to:
Increase language and communication skills
Attention and focus
Social skills
Memory
Academics
Decrease problem behaviors
ABA therapy has been offered to military families for years, but under a patchwork of programs with wildly varying eligibilities. Current ABA services are offered to a wider range of beneficiaries under a Demonstration Program with a single set of requirements. The Demonstration is scheduled to run through 2023, after already having been extended once.

5. Which military families qualify for TRICARE ABA?
Active Duty
Retired
Reserve and National Guard families while their service member is called to active federal duty
Families of retirees:
Since retired service members most likely have children who are older, it’s important for families to know that ABA benefits have no age limit. This is especially important as many state laws restrict the age of individuals receiving ABA through private insurance.
Reserve and National Guard families with a service member called to active federal duty:
For families in this category, it is useful to know that TRICARE covers ABA. It’s also important for them to know that TRICARE covers services such as speech and language, physical, and occupational therapies—which may help a family coping with the financial effects of a service member’s deployment. Not all employers continue a service member’s health insurance when they go on active duty.

6. Autism Demonstration-ABA therapy through TRICARE
No age limit
No duration limit
# of weekly hours based on the needs of individual child
No annual or lifetime dollar limit to amount of ABA services
Autism Spectrum diagnosis given by a TRICARE-authorized provider
ONLY ASD—no other conditions
ASD must be “moderate-to- severe”; an individual considered “high-functioning” will not qualify
The real-life limits to this benefit are related to cost-sharing: the costs for families of retired service members can be a shock to families used to lower health costs.
The other limitation is getting a provider authorized by TRICARE, as TRICARE may offer lower reimbursements and tighter regulation than private-sector insurance.
These difficulties must be balanced against the very thorough coverage with no age, duration, or dollar caps.

7. How do Military Families get ABA Therapy?
Assessment
Creation of treatment plan
Receive services
TRICARE Authorization
(Active-duty families must also enroll in EFMP & ECHO)
Diagnosis from approved provider per TRICARE website
The TRICARE website has contacts for a navigation process, but essentially they get a diagnosis, apply to TRICARE for authorization, and their family member will be assessed, get a treatment plan, and receive services.
Note that active duty families also need to enroll in the Exceptional Family Member Program, or EFMP, because autism services, including ABA, are limited overseas and in some areas of the United States. EFMP coordinates the service member’s duty assignments to try to make sure the family doesn’t end up somewhere their child can’t get services.
Active duty families must also sign up for the Extended Care Health Option, or ECHO, because it offers supplemental services helpful for individuals with ASD, as well as respite care for the parents. In this way active-duty families start off with access to benefits they may need for their child.

8. TRICARE-provided ABA and school services:
TRICARE covers ABA therapy for the child’s behaviors (out of school)
TRICARE does NOT cover ABA therapy for the child’s education (school may provide if available and in IEP)
This can be confusing for families getting benefits through ECHO or the Autism Demonstration, as TRICARE assessments are used to get authorization for those benefits. Families may believe either that TRICARE covers services in schools, or alternatively, that school services can also be received at home.
TRICARE only provides ABA therapy through the Autism Demonstration for a child’s behaviors, not for educational purposes.
Some other services that might be confusing are provided through ECHO, on the next slides.
When you are aware that TRICARE can provide ABA services outside of the school setting, which can supplement those received through an IEP, you can explain the distinction to military families.

9. Extended Care Health Option (ECHO)
ECHO is only available for active-duty families, not retirees, reserve, or National Guard----
EXCEPT: when reservists and National Guard service members are called to active duty (“activated”), their families are then eligible for the ECHO program
“The Extended Care Health Option (ECHO) provides financial assistance to beneficiaries with special needs for an integrated set of services and supplies.”
Can provide up to $36,000 per year
NOTE: if a family is also trying to access Medicaid services, ECHO pays first, and Medicaid is the secondary payer.
ECHO also offers ECHO Home Health Care for individuals who qualify

10. Who qualifies for ECHO? Individuals diagnosed with:
Moderate or severe intellectual disability
Serious physical disability
Extraordinary physical or psychological condition
Children may remain eligible for ECHO beyond the usual age limits in some circumstances (family must contact ECHO case manager)
At age 21, (or 23 if in college), children are no longer eligible to remain on their parent’s TRICARE plan.
If a child is not capable of self-support, the service member can go through a procedure to have the child declared an “incapacitated adult” in order for them to have continued TRICARE coverage and other military family benefits.
ECHO is not available for family members after the service member retires.

11. ECHO can pay for:
Medical and rehabilitative services, prostheses, orthopedic braces and appliances
Assistive services​
Durable equipment​
16 hours a month of respite care
Incontinence supplies
Training to use assistive technology devices
Institutional care when a residential environment is required
If an item is already covered through a family’s TRICARE plan, ECHO doesn’t cover it. It may be a good idea for families to check out what is already offered through TRICARE before submitting for an item through ECHO.

12. ECHO Home Health Care
Provides skilled nursing care for coverage in excess of regular TRICARE benefits
Respite care: 8 hours/day, 5 days/week –separate from the 16-hour ECHO respite benefit, cannot be used together in the same month
Medical social service, training and teaching, medical supplies

13. What are the requirements to get ECHO Home Health Care?
Individual must be homebound
Requires skilled services not covered under TRICARE’s regular Home Health Care coverage
Requires frequent interventions normally provided by primary caregivers

14. ECHO Home Health Care continued:
ECHO Home Health Care will pay for PT, OT, Speech-Languages pathology and similar services
These services are intended to reduce the disabling effects of an individual’s disability
Not to be confused with services on a child’s IEP, which are intended to give him access to education under the Individuals with Disabilities Education Act (IDEA)
Here is the other potentially confusing set of services for military families. If a child is homebound, he or she may be receiving special education services at home. The IEP may include PT, OT, speech-language pathology and similar services. It’s important that military parents understand that services provided by the schools are entirely separate from those received through TRICARE—they are for different purposes. Services provided through the schools allow a child to receive a free and appropriate public education. Services through ECHO rehabilitation or ECHO home health care are designed to address the disabling effects of a child’s particular disability.
Military parents may especially be confused by the ECHO requirement that families must use “publicly available services” before getting ECHO services. Services and supports from the school as a part of the child’s IEP are in a different category than publicly-available services for medical or rehabilitative purposes, and don’t apply to this ECHO limitation.

15. How can a family get ECHO? Family members must:
Have an ECHO qualifying condition
Enroll in the Exceptional Family Member Program (unless National Guard /Reserve)
Register in ECHO with the ECHO case manager
(TRICARE.mil)
National Guard and Reserve family members do not need to enroll in EFMP. ECHO case manager contact information is available on the TRICARE website, TRICARE.mil.

16. Resources
What is Secondary Dependency? Download and read as Word document TRICARE: Healthcare for Military Families Medicaid: Referring Military Families to Supports and Services Parent Handout Extended Care Health Option (ECHO) Parent handout

17. Want to reinforce your learning? Take this short quiz!
………..and finally……..

18. This document was produced under US Department of Education, Office of Special Education Programs No. H328R The views expressed herein do not necessarily represent the positions or policies of the Department of Education. No official endorsement by the US Department of Education of any product, commodity, service or enterprise mentioned in this publication is intended or should be inferred. This product is public domain. Authorization to reproduce it in whole or in part is granted. While permission to reprint this publication is not necessary, the citation should be: The Branch, MPTAC (retrieval date). (Title), Tacoma, WA. The Branch Staff.