TRICARE / HEALTHNET

Tricare insurance managed by Healthnet provides a benefit that is a supplement to other Tricare
health care plans.  This supplement currently referred to as PFPWD is being replaced in the near
future by ECHO.  ECHO will offer expanded services and an increased benefit.  Please read the
information below and at the links provided.  There are extra steps that families in the PFPWD will
need to take in order to be enrolled in the ECHO program.  

Program for Persons with Disabilities (PFPWD)
32 CFR 199.5(a)(1) "Purpose.  The primary purpose of the PFPWD is to assist in reducing the
disabling effects of a PFPWD qualifying condition." Autism is a qualifying condition.

Extended Care Health Option (ECHO)
32CFR 199.5(a)(2) "The purpose of the ECHO is to provide an additional financial resource for an
integrated set of services and supplies designed to assist in the reduction of the disabling
effects of the beneficiary’s qualifying condition. Services include those necessary to maintain,
minimize or prevent deterioration of function of an ECHO-eligible beneficiary."

Tricare Policy Manual 6010.54-M, ECHO, Chapter 9, Section 9.1, II, C
"The educational modality known as “Applied Behavioral Analysis (ABA)” is
included as a benefit under this issuance when provided by a TRICARE-authorized provider.
Payable services include periodic evaluation of the beneficiary, development of a treatment
plan, and training of individuals to provide services in accordance with the treatment plan.
TRICARE can also pay for the “hands-on” ABA services when provided by a TRICARE
authorized provider. However, TRICARE can not pay for such services when provided by
family members, trainers or other individuals who are not TRICARE-authorized providers."

SOURCES FOR MORE INFORMATION

Tricare Policy Manual - ECHO

Tricare Policy Manual - PFPWD

32CFR 199.5 TRICARE EXTENDED CARE HEALTH OPTION (ECHO)

Tricare Handbook Chapter 6, Program for Persons with Disabilities (PFPWD)

*Specialized Training of Military Families (STOMP)
STOMP offers helpful informaton on its website and two message boards.  The first message
board discusses PFPWD issues.  The second is specific to military families with family members
who have autism.  We have learned a lot of information about PFPWD, ECHO, autism, and much
more by reading the questions and comments posted by families.

EFM Connections  EFM Connections provides information on services and resources available to
military families with special medical or educational needs.

Military Health System  U.S. Department of Defense Health System web page.

myTricare.com  Tricare North Region's web page.

Contact Information
1-877-TRICARE     Healthnet Federal Services
916-351-5126         PFPWD Case Manager
916-353-6164         PFPWD Case Manager