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Federal Register / Vol. 86, No. 129 / Friday, July 9, 2021 / Rules and Regulations
rates are too high for the TRICARE
ECHO population given its low level of use today. Given that current uptake rates are less than 1 percent for the ECHO population not diagnosed with autism and 5 percent for the autismdiagnosed population, it is believed that with the new information disseminated regarding the benefit, uptake rates of between 1 and 5 percent 3 percent midpoint and 5 and 10 percent 7.5 percent mid-point for the two groups respectively are reasonable assumptions. These assumptions imply that, in FY18, 90 non-respite ECHO
users diagnosed with ASD 0.075
1,201 and 110 non-respite ECHO users with non-ASD diagnoses 0.03 3,680
would have used respite care if the expanded benefit had been available.
Assuming that these non-respite care ECHO users take on the same average respite care utilization and cost characteristics of their respite care user counterparts separately for those diagnosed with ASD and those with other diagnoses assumed under the new benefit, it is estimated that these new respite care ASD users would have had $212,753 in incremental costs and non-ASD users would have had $322,526 in respite care costs, for a total of $535,279, if the benefit had been available during FY18.
Finally, the additional respite care costs for the 11,138 patients who used the ACD and who were eligible for but did not use the ECHO program during FY18 was estimated. Under the proposed change, these patients would be able to use ECHO during any month of the year, and for the sole purpose of receiving respite care. To estimate costs for this group, the same approach noted above was used for ECHO program participants diagnosed with ASD who did not use respite care. First, it was assumed that 7.5 percent of the 11,138
ACD patients, or 835 patients, would use respite care services under the new policy. Assuming that these 835 ACD
patients would have the same average respite care utilization and cost characteristics of their ECHO user counterparts diagnosed with ASD
assumed under the new benefit, it was estimated that these ACD users would have had $1,973,055 in additional respite care costs, if the benefit had been available during FY18.
In summary, it is estimated that total costs of the new benefit would have been $2,690,569 or $182,235 +
$535,279 + $1,973,055 if the benefit had been available during FY18. The incremental costs would be $2,623,014
in FY18 which are equal to total new respite program costs minus baseline costs.

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B. Benefits ADFM ECHO beneficiaries would be able to use an expanded respite benefit that would allow them to obtain the benefit in any month of the year regardless of the use of non-respite ECHO services. Under this rule, ECHO
EHHC beneficiaries would continue to receive a more generous respite care benefit a maximum of 8 hours per day, 5 days a week.
C. Alternatives Two alternatives, besides this rulemaking action, were considered.
D No action. This alternative would not allow TRICARE to expand access to respite care services as recommended by the Military Compensation and Retirement Modernization Commission MCRMC, allowing families to access those hours without receiving another ECHO benefit during the same month the respite care is received. The results of this alternative are not preferred.
D Next Best Alternative. Expand the respite care benefit by increasing the Monthly Respite Maximum from 16 to 20 hours. Under this alternative, which assumes that both the concurrent care requirement is eliminated and the cap on monthly hours would be increased from 16 to 20 hours, health care costs are estimated as nearly $3.2 million in FY20. This alternative is not preferred.
D The Preferred Alternative is the final rule action being taken.
IV. Regulatory Procedures Executive Order 12866, Regulatory Planning and Review and Executive Order 13563, Improving Regulation and Regulatory Review Executive Orders E.O.s 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits including potential economic, environmental, public health and safety effects, distributive impacts, and equity. E.O. 13563 emphasizes the importance of quantifying both costs and benefits, reducing costs, harmonizing rules, and promoting flexibility. A regulatory impact analysis must be prepared for major rules with economically significant effects $100
million or more in any one year. This rulemaking is neither economically significant as measured by the $100
million threshold, nor is it otherwise significant.

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Congressional Review Act, 5 U.S.C.
8042
Pursuant to the Congressional Review Act 5 U.S.C. 801 et seq., the Office of Information and Regulatory Affairs designated this rule as not a major rule, as defined by 5 U.S.C. 8042.
Public Law 96354, Regulatory Flexibility Act RFA, Title 5, U.S.C., Sec. 601
The Assistant Secretary of Defense for Health Affairs certifies that this final rule is not subject to the Regulatory Flexibility Act 5 U.S.C. 601 et seq.
because it would not, if promulgated, have a significant economic impact on a substantial number of small entities.
Therefore, the Regulatory Flexibility Act, as amended, does not require us to prepare a regulatory flexibility analysis.
Public Law 1044, Sec. 202, Unfunded Mandates Reform Act Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any one year of $100 million in 1995
dollars, updated annually for inflation.
That threshold level is currently approximately $140 million. This final rule will not mandate any requirements for state, local, or tribal governments or the private sector.
Public Law 96511, Paperwork Reduction Act Title 44, U.S.C., Chapter 35
This rule will not impose significant additional information collection requirements on the public under the Paperwork Reduction Act of 1995 44
U.S.C. 35023511. Existing information collection requirements of the TRICARE
and Medicare programs will be utilized.
TRICARE ECHO respite care providers will be coding and filing claims in the same manner as they currently are with TRICARE.
Executive Order 13132, Federalism This rule has been examined for its impact under E.O. 13132, and it does not contain policies that have federalism implications that would have substantial direct effects on the States, on the relationship between the national Government and the States, or on the distribution of powers and responsibilities among the various levels of Government. Therefore, consultation with State and local officials is not required.

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