Federal Register / Vol. 86, No. 129 / Friday, July 9, 2021 / Rules and Regulations 36213 

Class E6 airspace designations are 

published in paragraph 6006 of FAA 

Order 7400.11E, dated July 21, 2020, 

and effective September 15, 2020, which 

is incorporated by reference in 14 CFR 

71.1. The Class E airspace designation 

listed in this document will be 

published subsequently in the Order. 

Availability and Summary of 

Documents for Incorporation by 

Reference 

This document amends FAA Order 

7400.11E, Airspace Designations and 

Reporting Points, dated July 21, 2020, 

and effective September 15, 2020. FAA 

Order 7400.11E is publicly available as 

listed in the ADDRESSES section of this 

document. FAA Order 7400.11E lists 

Class A, B, C, D, and E airspace areas, 

air traffic service routes, and reporting 

points. 

The Rule 

This amendment to 14 CFR part 71 

establishes Class E en route domestic 

airspace extending upward from 1,200 

feet above the surface at Mountain 

Home, ID. This action provides 

controlled airspace to facilitate 

vectoring of IFR aircraft under the 

control of Salt Lake City ARTCC. The 

airspace also ensures proper 

containment of IFR aircraft operating on 

direct routes where the current en route 

structure is insufficient. 

FAA Order 7400.11, Airspace 

Designations and Reporting Points, is 

published yearly and effective on 

September 15. 

Regulatory Notices and Analyses 

The FAA has determined that this 

regulation only involves an established 

body of technical regulations for which 

frequent and routine amendments are 

necessary to keep them operationally 

current, is non-controversial, and 

unlikely to result in adverse or negative 

comments. It, therefore: (1) Is not a 

‘‘significant regulatory action’’ under 

Executive Order 12866; (2) is not a 

‘‘significant rule’’ under DOT 

Regulatory Policies and Procedures (44 

FR 11034; February 26, 1979); and (3) 

does not warrant preparation of a 

regulatory evaluation as the anticipated 

impact is so minimal. Since this is a 

routine matter that will only affect air 

traffic procedures and air navigation, it 

is certified that this rule, when 

promulgated, would not have a 

significant economic impact on a 

substantial number of small entities 

under the criteria of the Regulatory 

Flexibility Act. 

Environmental Review 

The FAA has determined that this 

action qualifies for categorical exclusion 

under the National Environmental 

Policy Act in accordance with FAA 

Order 1050.1F, ‘‘Environmental 

Impacts: Policies and Procedures,’’ 

paragraph 5–6.5a. This airspace action 

is not expected to cause any potentially 

significant environmental impacts, and 

no extraordinary circumstances exist 

that warrant the preparation of an 

environmental assessment. 

List of Subjects in 14 CFR Part 71 

Airspace, Incorporation by reference, 

Navigation (air). 

Adoption of the Amendment 

In consideration of the foregoing, the 

Federal Aviation Administration 

amends 14 CFR part 71 as follows: 

PART 71—DESIGNATION OF CLASS A, 

B, C, D, AND E AIRSPACE AREAS; AIR 

TRAFFIC SERVICE ROUTES; AND 

REPORTING POINTS 

■ 1. The authority citation for 14 CFR 

part 71 continues to read as follows: 

Authority: 49 U.S.C. 106(f), 106(g), 40103, 

40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 

1959–1963 Comp., p. 389. 

§ 71.1 [Amended] 

■ 2. The incorporation by reference in 

14 CFR 71.1 of FAA Order 7400.11E, 

Airspace Designations and Reporting 

Points, dated July 21, 2020, and 

effective September 15, 2020, is 

amended as follows: 

Paragraph 6006 En Route Domestic 

Airspace Areas. 

* * * * * 

ANM ID E6 Mountain Home, ID [New] 

That airspace extending upward from 

1,200 feet above the surface within an area 

beginning at lat. 43°05′36′′ N, long 114°51′26′′ 

W, to lat. 42°26′27′′ N, long. 114°57′44′′ W; 

to lat. 42°25′53′′ N, long. 116°03′43′′ W; to lat. 

43°07′42′′ N, long. 116°44′08′′ W; to lat. 

44°03′18′′ N, long. 117°05′05′′ W; to lat. 

44°15′42′′ N, long. 116°19’’34’’ W; to lat. 

44°03′41′′ N, long. 116°12′15′′ W; to lat. 

43°58′04′′ N, long. 115°51′09′′ W; to lat. 

43°47′52′′ N, long. 115°41′21′′ W; to lat. 

43°30′14′′ N, long. 115°36′38′′ W; to lat. 

43°17′24′′ N, long. 115°41′05′′ W; to lat. 

43°03′38′′ N, long. 115°19′32′′ W; then to the 

point of beginning. 

Issued in Des Moines, Washington, on July 

1, 2021. 

B.G. Chew, 

Acting Group Manager, Operations Support 

Group, Western Service Center. 

[FR Doc. 2021–14556 Filed 7–8–21; 8:45 am] 

BILLING CODE 4910–13–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

32 CFR Part 199 

[Docket ID: DOD–2016–HA–0112] 

RIN 0720–AB69 

TRICARE: Extended Care Health 

Option (ECHO) Respite Care 

AGENCY: Office of the Secretary, 

Department of Defense (DoD). 

ACTION: Final rule. 

SUMMARY: The Department of Defense is 

amending the TRICARE regulation to 

allow an ECHO program beneficiary to 

receive, when authorized, up to sixteen 

(16) hours of respite care per month 

without a prerequisite to receive other 

authorized non-respite care during the 

same month. Currently, Active Duty 

Family Members who are eligible for the 

ECHO program can receive a maximum 

of 16 hours of respite care per month, 

in any calendar month in which the 

beneficiary receives other non-respite 

ECHO benefits (referred to as 

‘‘concurrent’’ care). As the specific 

requirement for a concurrent ECHO 

benefit, which was originally 

implemented to ensure optimal medical 

management of the beneficiary’s ECHOqualifying condition, is no longer 

necessary and may serve as an 

inappropriate barrier to receipt of 

respite services for some families, this 

final rule will eliminate the concurrent 

ECHO benefit requirement and allow an 

ECHO beneficiary to receive up to a 

maximum of 16 hours of respite care per 

month, regardless of whether another 

ECHO benefit is received in the same 

month. 

DATES: This rule is effective August 9, 

2021. 

FOR FURTHER INFORMATION CONTACT: Ms. 

Carmen DeLeon, Defense Health 

Agency, TRICARE Health Plan Division, 

Telephone 210–536–6004. 

SUPPLEMENTARY INFORMATION: 

I. Executive Summary 

A. Regulatory History 

The Department published a proposed 

rule in the Federal Register on August 

17, 2018 (83 FR 41026–41029) to 

eliminate the requirement for a 

beneficiary to receive a concurrent 

ECHO benefit in order to qualify for 

respite care. This change will expand 

access to respite care services (as 

recommended by the Military 

Compensation and Retirement 

Modernization Commission (MCRMC)), 

allowing families to access those hours 


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without receiving another ECHO benefit 

during the same month the respite care 

is received. 

B. Summary of Major Provisions 

The Department of Defense (the 

Department) remains committed to 

supporting Service members and their 

family members with special needs. 

Together, the Office of Community 

Support for Military Families with 

Special Needs, the Services, and the 

Military Health System are working to 

enhance and improve support for these 

families, including everything from 

complex medical management to nonclinical case management and family 

support services. The Department is also 

committed to eliminating unnecessary 

requirements that act as barriers to care. 

The requirement to receive a concurrent 

ECHO benefit in order to be entitled to 

ECHO respite care was originally 

imposed as a medical management tool. 

We now conclude that this specific 

requirement is no longer necessary and 

may serve as an inappropriate barrier to 

receipt of respite services for some 

families. Respite services for ECHOeligible covered beneficiaries may still 

be appropriate and necessary even when 

no other ECHO services are provided 

(i.e., where all needed care is otherwise 

covered under the TRICARE Basic 

Program or under demonstration 

authority). 

The elimination of the requirement 

for a simultaneous ECHO benefit will 

provide maximum flexibility to families 

without sacrificing the goal of ensuring 

the safe and effective management of the 

beneficiary’s ECHO qualifying 

condition. First, we note that TRICARE 

beneficiaries with complex medical 

needs may receive case management 

services including medical 

management, disease management and 

chronic care coordination, under the 

TRICARE Basic Program, regardless of 

whether the beneficiary is an ECHO 

eligible beneficiary. As the TRICARE 

program has evolved over time, 

continuing to require an ECHO eligible 

beneficiary to receive a concurrent 

ECHO benefit as a medical management 

tool is no longer necessary. Based on 

our current program structure, 

beneficiaries should already be 

receiving medical management services 

and the receipt of any ECHO benefit, 

including ECHO respite care, provides 

an additional opportunity to ensure the 

safe and effective management of the 

beneficiary’s qualifying condition. 

Furthermore, in accordance with 32 

CFR 199.5(h)(3), all ECHO benefits, 

including ECHO respite care, require 

authorization prior to receipt of such 

benefits. Paragraph 199.5(i) discusses 

required documentation as a 

prerequisite to authorizing ECHO 

benefits. As a practical matter, the Home 

Health Aide (HHA) providing the 

respite services must document the 

health care services needed by the 

ECHO beneficiary in the absence of the 

family caregiver and the schedule for 

the services during the provision of 

respite care in order to ensure an 

appropriately trained provider is sent 

and the beneficiary’s needs are met. 

Additional details regarding required 

documentation to be provided to the 

Managed Care Support Contractor and 

HHA for authorization of ECHO respite 

services will be published in the 

TRICARE Policy Manual available at 

http://manuals.tricare.osd.mil. We 

believe that this approach will provide 

greater flexibility and eliminate 

unnecessary barriers for families to 

access ECHO respite care services while 

still ensuring the safe and effective 

medical management of the 

beneficiary’s qualifying condition(s). 

C. Legal Authority for This Program 

The ECHO program is authorized by 

10 United States Code (U.S.C.) 1079(d)– 

(f), and has been implemented through 

regulation at 32 CFR 199.5 (available at 

https://www.govregs.com/regulations/ 

title32_chapterI_part199_section199.5). 

Per 32 CFR 199.5(c)(7), ECHO 

beneficiaries are eligible for a maximum 

of 16 hours of respite care per month in 

any month during which the beneficiary 

otherwise receives an ECHO (other than 

the ECHO Home Health Care (EHHC)) 

benefit(s). This regulation is finalized 

under the authority of 5 U.S.C. 301 

(available at https://www.govregs.com/ 

uscode/title5_partI_chapter3_

subchapterI), which allows the 

Secretary of Defense to prescribe 

regulations for the government; and 10 

U.S.C. 1079(d) and (e) (available at 

https://www.govregs.com/uscode/ 

title10_subtitleA_partII_chapter55), 

which directs the Secretary of Defense 

to establish a program to provide 

extended benefits for eligible active 

duty dependents, which may include 

the provision of comprehensive health 

care services, including case 

management services, to assist in the 

reduction of the disabling effects of a 

qualifying condition of an eligible 

dependent. The Department is 

authorized to provide ‘‘respite care for 

the primary caregiver of the eligible 

dependent’’ as one of the specifically 

enumerated extended benefits under the 

ECHO program pursuant to 10 U.S.C. 

1079(e)(6). 

II. Public Comments 

Comments were received from thirtyone individuals, medical affiliated 

organizations, and military and veterans 

associations via www.regulations.gov. 

We have carefully considered all public 

comments, and specific matters raised 

by those comments are summarized 

below. We reaffirm the policies and 

procedures contained in the proposed 

rule and maintain the rationale 

presented in the preamble of the 

proposed rule. 

A. Analysis of Public Comments 

The government received many 

comments that were in favor of the 

elimination of the concurrent ECHO 

benefit requirement. Many comments 

also noted that a minimum increase of 

four hours to the current sixteen hours 

(total of twenty hours per month) was 

reasonable. 

Response: Increasing the number of 

respite hours per month from 16 to 20 

is a major change and under the law we 

must give the public notice and an 

opportunity for comment. Therefore, an 

increase in respite hours will not be 

incorporated under this final rule. A 

separate rule will be considered by the 

Department when further analysis of the 

appropriate number of hours of respite 

is conducted. 

Two of these comments 

recommended consideration that the 

respite program be open to more 

providers than just HHAs as some 

beneficiaries do not require a home 

health nurse or aide to provide respite 

care to children with autism. 

Response: Respite care consists of 

providing skilled and non-skilled 

services to a beneficiary such that in the 

absence of the primary caregiver, 

management of the beneficiary’s ECHO 

qualifying condition and safety are 

provided. Therefore, 32 CFR part 1079 

requires a TRICARE-authorized HHA 

provide the services under the ECHO 

program. This is critical to ensure the 

safety of our beneficiaries. 

Twenty-four comments were received 

in which commenters requested that the 

ECHO respite benefit be aligned with 

the Medicaid Home and Community 

waiver per the 2015 MCRMC which 

asked that a transitional benefit be made 

available to cover families that are 

separating or retiring from active duty 

(AD) service. 

Response: By law, ECHO is available 

only to ADFMs and therefore a 

transitional benefit to cover families that 

are separating or retiring from AD 

service would require legislation. 

We received two comments indicating 

that there are several geographic areas 


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that cannot obtain service due to a lack 

of providers, or that providers have 

declined to accept a beneficiary when 

limited to 16 hours per month. 

Response: As previously stated, in 

order to assure the quality of care for 

ECHO beneficiaries, all ECHO respite 

care services will be provided only by 

Medicare or Medicaid certified HHAs 

who have in effect at the time of 

services a valid agreement to participate 

in the TRICARE program. Consequently, 

ECHO respite services are available only 

in locations where there are Medicare or 

Medicaid certified HHAs. 

Four comments included requests for 

the benefit to allow sibling care from the 

same HHA that is providing ECHO 

respite care. 

Response: While this request is 

understandable, 32 CFR 199.5 requires 

respite care services be provided by a 

TRICARE-authorized HHA and are 

designed to provide health care services 

for the covered beneficiary. Child-care 

services for other members of the family 

is not authorized medical care. 

One comment sought clarification on 

the amount of respite hours and impact 

on yearly cost, and specifically asked 

whether the respite hours would be 

incorporated into the yearly benefit 

limitations. 

Response: Yes, by law, the cost of 

respite care under ECHO will be 

calculated into the yearly benefit. The 

Government’s share of the total cost of 

providing such benefits in any year 

shall not exceed $36,000. 

B. Provisions of the Final Rule 

The final rule is consistent with the 

proposed rule. No changes were made to 

the rule text as a result of comments 

received; however, certain provisions 

discussed in the proposed rule have 

been deleted from the final rule (e.g., 

increasing authorized hours beyond 16 

per month). 

III. Regulatory Analysis 

A. Cost Estimate: No Concurrent Care 

Requirement and 16 Hours per Month 

Limit 

Current Policy Baseline Costs— 

Baseline (current policy) respite care 

costs incurred for those ECHO 

beneficiaries were estimated using 

respite care in FY18 (the latest full fiscal 

year data available). Out of a total of 

1,267 ECHO users diagnosed with ASD, 

there were 66 respite care users who 

incurred $48,022 in paid costs for 

respite care billing codes (S9122, S9123, 

and S9124). Of these 66 users, 17 

incurred the maximum of 16 hours per 

month over an average of 1.7 months 

(total paid amount of $10,969) and 49 

incurred an average of 11.3 hours per 

month over an average of 2.8 months 

(total paid amount of $37,053). Out of a 

total of 3,689 ECHO users with non-ASD 

diagnoses, there were 9 respite care 

users who incurred $19,533 in paid 

costs for the three respite care billing 

codes. Of these 9 users, 4 incurred the 

maximum of 16 hours per month over 

an average of 7.5 months (total paid 

amount of $12,262) and 5 incurred an 

average of 13.0 hours per month over an 

average of 4.4 months (total paid 

amount of $7,271). Because these users 

are not in the EHHC program, most of 

these expenditures were for respite-like 

services. As a result, FY18 baseline 

costs for ECHO respite care were 

$67,555 ($10,969 + $37,053 + $12,262 + 

$7,271; see Table 1). 

Cost of an Expanded Non-Concurrent 

Respite Benefit—Incremental respite 

costs were estimated under the 

proposed policy change that would not 

require concurrent care for two groups 

of ECHO beneficiaries: (1) Those who 

used ECHO respite care in FY18 and (2) 

those who only used non-respite ECHO 

care in FY18. The costs associated with 

ADFMs using the Autism Care 

Demonstration (ACD), who are not 

currently using the respite care benefit, 

were also estimated. All of these ADFM 

beneficiaries using the ACD are enrolled 

in ECHO and would be eligible to use 

respite care under the non-concurrent 

policy change. 

In estimating the potential costs of the 

policy change, beneficiaries who used 

ECHO respite care in FY18 were first 

examined. As discussed above, in FY18 

there were a total of 75 respite care 

users: 66 diagnosed with ASD and 9 

with non-ASD diagnoses. It was 

assumed that their average number of 

respite care hours per month and the 

paid amount per month would not 

change under the new benefit. However, 

it was also assumed that the average 

number of months that they would 

utilize respite care would increase 

because the number of respite care 

months after the change would now be 

unconstrained (up to a maximum of 12 

months) due to the absence of 

concurrency. To estimate the average 

number of respite care months per user, 

FY18 data from the Comprehensive 

Autism Care Demonstration (ACD) was 

examined. It was determined that 

ADFM patients had an average (and 

median) of 8 months of care in the ACD 

during FY18. As a result, 8 months is a 

reasonable proxy for the number of 

months of respite care an average 

patient would use if the number of 

months were not constrained. Therefore, 

it was assumed that the average 

patient’s family would use respite care 

services for 8 months on average. 

Baseline respite users were multiplied 

first by average months per year of 

respite care per user, then by average 

respite hours per month, and lastly by 

average paid amount per hour for 

respite care. This results in an estimated 

total of $182,235 in paid costs under the 

new benefit for baseline respite care 

users ($51,441 + $104,495 + $13,079 + 

$13,220). 

Then, added costs for those 

beneficiaries currently using only nonrespite ECHO care during FY18 were 

estimated. In order to estimate respite 

care user uptake rates under the 

expanded benefit, it is important to 

understand why current rates for nonEHHC ECHO users are so low (between 

0.2 percent for patients not diagnosed 

with autism and 5 percent for patients 

diagnosed with autism). The National 

Respite Coalition Task Force has 

surveyed families in the civilian world 

on the reasons why respite care uptake 

is low. Five reasons possibly apply to 

ECHO beneficiaries: Restrictive 

eligibility criteria, lack of information 

about respite program availability, 

inadequate supply of trained providers, 

inability to relate to or trust non-family 

caregivers, and guilt. The Department 

concludes that a revised policy for 

ECHO respite care would be largely 

influenced by the first two reasons: The 

extent to which restricted eligibility 

criteria will be reduced (in our case 

concurrency will no longer be required) 

and the extent to which the current lack 

of information about ECHO’s respite 

benefit is reduced. Consequently, the 

Department concludes that utilization 

rates under the revised ECHO respite 

benefit will largely be dependent upon 

(1) the fact that the respite benefit will 

now be available in all 12 months of the 

year independent of non-respite care 

ECHO use, and (2) the extent to which 

the new respite benefit would be 

promoted by the MCSCs, the 

Exceptional Family Member Program 

(EFMP), DHA, and related advocacy 

groups. 

Some new beneficiaries may be drawn 

into the program because of the value of 

the new benefit (i.e., that it can be used 

in any month). Also, others could be 

drawn to use respite care because of 

promotion of the benefit through 

various media by interested parties. The 

MCSCs, EFMP, advocacy groups (e.g., 

Autism Speaks) and DHA will likely 

provide information by means of 

newsletters, web page postings, and 

other media. This information would 

then spread by word of mouth and online chat groups. While some studies 

have suggested respite care uptake rates 

of 15 to 20 percent, it is likely that these 


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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. 

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. 

Congressional Review Act, 5 U.S.C. 

804(2) 

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. 804(2). 

Public Law 96–354, ‘‘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 104–4, 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 96–511, ‘‘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. 3502–3511). 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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List of Subjects in 32 CFR Part 199 

Claims, Dental health, Health care, 

Health insurance, Individuals with 

disabilities, Military personnel. 

Accordingly, 32 CFR part 199 is 

amended as follows: 

PART 199—CIVILIAN HEALTH AND 

MEDICAL PROGRAM OF THE 

UNIFORMED SERVICES CHAMPUS 

■ 1. The authority citation for part 199 

continues to read as follows: 

Authority: 5 U.S.C. 301; 10 U.S.C. chapter 

55. 

■ 2. In § 199.5, revise paragraph (c)(7) 

introductory text to read as follows: 

§ 199.5 TRICARE Extended Care Health 

Option (ECHO). 

* * * * * 

(c) * * * 

(7) Respite care. TRICARE 

beneficiaries enrolled in ECHO are 

eligible for a maximum of 16 hours of 

respite care per month. Respite care is 

defined in § 199.2. Respite care services 

will be provided by a TRICAREauthorized HHA and will be designed to 

provide health care services for the 

covered beneficiary. The benefit will not 

be cumulative, that is, any respite hours 

not used in one month will not be 

carried over or banked for use on 

another occasion. 

* * * * * 

Dated: July 2, 2021. 

Aaron T. Siegel, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 2021–14614 Filed 7–8–21; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF EDUCATION 

34 CFR Chapter II 

[Docket ID ED–2021–OESE–0045] 

Final Priorities—Effective Educator 

Development Division 

AGENCY: Office of Elementary and 

Secondary Education, Department of 

Education. 

ACTION: Final priorities. 

SUMMARY: The Department of Education 

(Department) announces priorities for 

the following programs of the Effective 

Educator Development Division (EED): 

Teacher and School Leader Incentive 

Grants (TSL), Assistance Listing 

Number (ALN) 84.374A; Supporting 

Effective Educator Development (SEED), 

ALN 84.423A; and Teacher Quality 

Partnership (TQP), ALN 84.336S. We 

may use these priorities for 

competitions in fiscal year (FY) 2021 

and later years. We propose these 

priorities to focus on educator 

development, leadership, and diversity 

in the various EED programs in order to 

improve the quality of teaching and 

school leadership. 

DATES: These priorities are effective 

August 9, 2021. 

FOR FURTHER INFORMATION CONTACT: 

Orman Feres, U.S. Department of 

Education, 400 Maryland Avenue SW, 

Room 3C124, Washington, DC 20202. 

Telephone: (202) 453–6921. Email: 

orman.feres@ed.gov. 

If you use a telecommunications 

device for the deaf (TDD) or a text 

telephone (TTY), call the Federal Relay 

Service (FRS), toll free, at 1–800–877– 

8339. 

SUPPLEMENTARY INFORMATION: 

Purpose of Program: This notice 

identifies final priorities for use in three 

Department programs: TSL, SEED, and 

TQP. The purpose of TSL is to assist 

States, local educational agencies, and 

nonprofit organizations to develop, 

implement, improve, or expand 

comprehensive performance-based 

compensation systems (PBCS) or human 

capital management systems (HCMS) for 

teachers, principals, and other school 

leaders (educators) (especially educators 

in high-need schools who raise student 

academic achievement and close the 

achievement gap between high- and 

low-performing students). In addition, a 

portion of TSL funds may be used to 

study the effectiveness, fairness, quality, 

consistency, and reliability of such 

systems. The SEED program provides 

funding to increase the number of 

highly effective educators by supporting 

the implementation of evidence-based 

practices that prepare, develop, or 

enhance the skills of educators. SEED 

grants allow eligible entities to develop, 

expand, and evaluate practices that can 

serve as models to be sustained and 

disseminated. The purposes of the TQP 

program are to improve student 

achievement; improve the quality of 

prospective and new teachers by 

improving the preparation of 

prospective teachers and enhancing 

professional development activities for 

new teachers; hold teacher preparation 

programs at institutions of higher 

education accountable for preparing 

teachers who meet applicable State 

certification and licensure requirements; 

and recruit highly qualified individuals, 

including minorities and individuals 

from other occupations, into the 

teaching profession. 

Program Authority: 20 U.S.C. 1221e– 

3. TSL: Sections 2211–2213 of the 

Elementary and Secondary Education 

Act of 1965, as amended (ESEA), 20 

U.S.C. 6631–6633. SEED: Section 2242 

of the ESEA, 20 U.S.C. 6672. TQP: 

Sections 200–204 of the Higher 

Education Act of 1965, as amended, 20 

U.S.C. 1021–1022c. 

We published a notice of proposed 

priorities (NPP) for these programs in 

the Federal Register on April 20, 2021 

(86 FR 20471). The NPP contained 

background information and our reasons 

for proposing the particular priorities. 

Except for minor editorial and 

technical revisions, there are no 

differences between the proposed 

priorities and these final priorities. 

Public Comment: In response to our 

invitation in the NPP, we received 31 

comments, 23 of which were relevant to 

the proposed priorities and 8 of which 

were not relevant to the proposed 

priorities and were not considered in 

the analysis. Of the 23 comments 

addressing the proposed priorities, 7 

expressed support for the proposed 

priorities but either offered no specific 

recommendations to revise them or 

offered broad recommendations for 

strengthening the educator workforce 

that were outside the scope of these 

proposed priorities. The remaining 16 

comments either expressed 

disagreement or broadly agreed while 

offering suggestions to strengthen the 

proposed priorities. Responses to these 

comments are found in the Analysis of 

the Comments and Changes below. 

Analysis of the Comments and 

Changes: An analysis of the comments 

and of any changes to the proposed 

priorities follows. Generally, we do not 

address technical and other minor 

changes, or suggested changes the law 

does not authorize us to make under the 

applicable statutory authority. In 

addition, we do not address general 

comments that raise concerns not 

directly related to the NPP. 

Comment: In response to Priority 1— 

Supporting Educators and Their 

Professional Growth, one commenter 

suggested that encouraging educators to 

pursue advanced credentials, such as 

Master’s degrees, may not necessarily 

lead to improvements in educator 

effectiveness and may produce 

unintended incentives for educators to 

leave the profession. 

Discussion: We appreciate the 

comment regarding the potential limited 

impact on educator effectiveness and 

potential disincentives to educator 

retention that could result from 

encouraging teachers to pursue 

advanced credentials. Creating or 

enhancing professional growth 


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