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Federal Register / Vol. 86, No. 169 / Friday, September 3, 2021 / Rules and Regulations This may, in turn, increase utilization of medical services for these individuals, resulting in net benefits to society to the extent that they provide benefits net of the costs of delivering these medical services. Although this increased utilization would represent a cost, it may result in a net benefit depending on the extent to which it improves health outcomes. OPM lacks data to estimate these impacts, and we request comment on data or methods to estimate potential impacts.
Access to FEHB for more tribal employees may help to reduce health disparities. According to a Kaiser Family Foundation report published in 2017, among nonelderly adults, AI/AN
are more likely than other adults to report being in fair or poor health, being overweight or obese, and having diabetes.8 In addition, suicide disproportionately affects AI/AN, and in a CDC study, AI/AN decedents had lower odds than did White decedents of having received a mental health diagnosis or mental health treatment.9
Recently, health disparities have been highlighted for AI/AN, who have experienced disproportionate rates of infection and mortality during the COVID19 pandemic.10 For persons aged 2029 years, 3039 years, and 40
49 years, the COVID19 mortality rates among AI/AN were 10.5, 11.6, and 8.2
times, respectively, those among White persons.10 Increasing access to affordable healthcare is a way to improve access to medical and mental health services and may mitigate inequities. This rule may mitigate health inequities to the extent that it increases access to medical care.

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Effects on Other Parties As described above, one expected impact of this rule is that affected tribal employees will gain access to health insurance plans with lower health insurance premiums. A reduction in those premiums reflects transfers between various parties involved in States Subcommittee Legislative Hearing on H.R.
895, the Tribal School Federal Insurance Parity Act July 16, 2019, available at https
www.congress.gov/116/meeting/house/109791/
witnesses/HHRG-116-II24-Wstate-FirethunderC20190716.pdf.
8 See Kaiser Family Foundation, Medicaid and American Indians and Alaska Natives, September 7, 2017, https www.kff.org/medicaid/issue-brief/
medicaid-and-american-indians-and-alaskanatives/.
9 See Suicides Among American Indian/Alaska NativesNational Violent Death Reporting System, 18 States, 20032014. Morbidity and Mortality Weekly Reports, 678. March 2, 2018. Centers for Disease Control and Prevention. Available at https www.cdc.gov/mmwr/volumes/67/wr/pdfs/
mm6708a1-H.pdf.
10 Id.

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these transactions. The clearest effect is a transfer toward parties paying for health benefits absent the expansion of FEHB benefits, which largely include tribal employers and employees. This transfer is most likely to come initially from reductions in payments to health insurance providers or from offsetting increases in FEHB health insurance premiums. We expect that, due to medical loss ratio13 regulations, premiums largely reflect medical costs experienced by those insured by the plan. As a result, we expect that the rule will largely initially result in a transfer from those paying FEHB premiums including enrollees and the Federal government in the baseline to entities who experience premium reductions under this rule. As described above, we expect these effects to be quite small.
However, we lack data to estimate the magnitude of these effects, and request public comment on data or methods to estimate any potential impacts.
Alternative Regulatory Approaches OPM is unaware of feasible alternatives to this rule, as this regulation aligns FEHB eligibility with the FY21 CAA, which amended section 409 of the IHCIA. Currently, OPM
regulations do not include FEHB
eligibility for Indian tribes or tribal organizations carrying out programs under the TCSA, and this rule expands eligibility along these lines. We request public comment on alternative approaches to this rule which would generate net benefits for the public.
Regulatory Flexibility Act I certify that this regulation will not have a significant economic impact on a substantial number of small entities.
Federalism We have examined this rule in accordance with Executive Order 13132, Federalism, and have determined that this rule will not have any negative impact on the rights, roles and responsibilities of State, local, or Tribal governments.
Civil Justice Reform This regulation meets the applicable standard set forth in Executive Order 12988.
Unfunded Mandates Reform Act of 1995
This rule will not result in the expenditure by State, local or Tribal governments of more than $100 million annually. Thus, no written assessment of unfunded mandates is required.

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Congressional Review Act Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 also known as the Congressional Review Act 5 U.S.C. 801 et seq.
requires rules as defined in 5 U.S.C.
804 to be submitted to Congress before taking effect. OPM will submit to Congress and the Comptroller General of the United States a report regarding the issuance of this action before its effective date, as required by 5 U.S.C.
801. OMBs Office of Information and Regulatory Affairs has determined that this is not a major rule as defined by the Congressional Review Act 5 U.S.C.
8042.
Paperwork Reduction Act of 1995 44
U.S.C. Chapter 35
Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act of 1995 44 U.S.C. 3501
et seq. PRA, unless that collection of information displays a currently valid Office of Management and Budget OMB Control Number.
This rule involves an OMB approved collection of information subject to the PRA for the FEHB Program, OMB No.
32060160, Health Benefits Election Form. The public reporting burden for this collection is estimated to average 30
minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The total burden hour estimate for this form is 9,000 hours.
The systems of record notice for this collection is: OPM/Central23, FEHB
Program Enrollment Records, available at https www.federalregister.gov/d/
2021-01259.
List of Subjects in 5 CFR Part 890
Administrative practice and procedure, Government employees, Health facilities, Health insurance, Health professions, Hostages, Indians, Iraq, Kuwait, Lebanon, Military personnel, Reporting and recordkeeping requirements, Retirement.
Office of Personnel Management.
Alexys Stanley, Regulatory Affairs Analyst.

Accordingly, OPM amends title 5, Code of Federal Regulations part 890 as follows:

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