Are there any circumstances in which ECHO provides custodial care?
Custodial care services, i.e., services that are designed mainly to assist the individual with the activities of daily living, will not be provided as a stand-alone benefit by ECHO. However, those services may be provided by ECHO when included in the EHHC plan of care in conjunction with medically necessary skilled services provided by EHHC. • Explain the EHHC monthly cap calculation. The maximum amount to be reimbursed for EHHC in any month shall not exceed 1/12 the annual benefit cap as adjusted for the actual number of days in the month EHHC services were provided. TriWest will calculate the maximum annual benefit only once per beneficiary per fiscal year, then authorize EHHC care in an amount not to exceed the allowed amount as discussed above. It is not subject to the $36,000 fiscal year cap.
