Quiero saber acerca de...

lotter on DSK11XQN23PROD with RULES2

Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations Treasury, or the Secretary of Labor as part of the certification process;
D In conducting payment determinations, including those outside the Federal IDR process, the IDR entity has failed to meet the standards that applied to those determinations or reviews, including standards of independence and impartiality; or E The IDR entity is otherwise not fit or qualified to make determinations under the Federal IDR process.
ii Revocation of certification of a certified IDR entity. The Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, may revoke the certification of a certified IDR entity under paragraph e1 of this section if, as a result of an audit, a petition described in paragraph e5 of this section, or otherwise, the Secretary determines the following:
A The certified IDR entity has a pattern or practice of noncompliance with any requirements of this paragraph e;
B The certified IDR entity is operating in a manner that hinders the efficient and effective administration of the Federal IDR process;
C The certified IDR entity no longer meets the applicable standards for certification set forth under this paragraph e;
D The certified IDR entity has committed or participated in fraudulent or abusive activities, including submission of false or fraudulent data to the Secretary, the Secretary of the Treasury, or the Secretary of Labor;
E The certified IDR entity lacks the financial viability to provide arbitration under the Federal IDR process;
F The certified IDR entity has failed to comply with requests from the Secretary, the Secretary of the Treasury, or the Secretary of Labor made as part of an audit, including failing to submit all records of the certified IDR entity that pertain to its activities within the Federal IDR process; or G The certified IDR entity is otherwise no longer fit or qualified to make determinations.
iii Notice of denial or revocation.
The Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, will issue a written notice of denial to the IDR entity or revocation to the certified IDR entity within 10
business days of the Secretarys decision, including the effective date of denial or revocation, the reasons for denial or revocation, and the opportunity to request appeal of the denial or revocation.
iv Request for appeal of denial or revocation. To request an appeal, the IDR entity or certified IDR entity must
VerDate Sep<11>2014

22:02 Oct 06, 2021

Jkt 256001

submit a request for appeal to the Secretary within 30 business days of the date of the notice under paragraph e6iii of this section of denial or revocation and in the manner prescribed by the instructions to the notice. During this time period, the Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, will not issue a notice of final denial or revocation and a certified IDR entity may continue to work on previously assigned determinations but may not accept new determinations. If the IDR entity or certified IDR entity does not timely submit a request for appeal of the denial or revocation, the Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, will issue a notice of final denial or revocation to the IDR
entity or certified IDR entity if applicable and the petitioner.
v Denial or final revocation. Upon notice of denial or final revocation, the IDR entity shall not be considered a certified IDR entity and therefore shall not be eligible to accept payment determinations under the Federal IDR
process. Moreover, after a notice of final revocation, the IDR entity may not reapply to be a certified IDR entity until on or after the 181st day after the date of the notice of denial or final revocation.
f Reporting of information relating to the Federal IDR process1 Reporting of information. Within 30 business days of the close of each month, for qualified IDR items and services furnished on or after January 1, 2022, each certified IDR
entity must, in a form and manner specified by the Secretary, report:
i The number of notices of IDR
initiation submitted under paragraph b2 of this section to the certified IDR
entity during the immediately preceding month;
ii The size of the provider practices and the size of the facilities submitting notices of IDR initiation under paragraph b2 of this section during the immediately preceding month, as required to be provided to the certified IDR entity under paragraph c4iA2 of this section;
iii The number of such notices of IDR initiation with respect to which a determination was made under paragraph c4ii of this section;
iv The number of times during the month that the out-of-network rate determined or agreed to under this section has exceeded the qualifying payment amount, specified by qualified IDR items and services;
v With respect to each notice of IDR
initiation under paragraph b2 of this section for which such a determination was made, the following information:

PO 00000

Frm 00155

Fmt 4701

Sfmt 4700

56133

A A description of the qualified IDR
items and services included with respect to the notification, including the relevant billing and service codes;
B The relevant geographic region for purposes of the qualifying payment amount for the qualified IDR items and services with respect to which the notification was provided;
C The amount of the offer submitted under paragraph c4i of this section by the plan or issuer as applicable and by the provider or facility as applicable expressed as a dollar amount and as a percentage of the qualifying payment amount;
D Whether the offer selected by the certified IDR entity under paragraph c4 of this section was the offer submitted by the plan or issuer as applicable or by the provider or facility as applicable;
E The amount of the selected offer expressed as a dollar amount and as a percentage of the qualifying payment amount;
F The rationale for the certified IDR
entitys decision, including the extent to which the decision relied on the criteria in paragraph c4iv of this section;
G The practice specialty or type of each provider or facility, respectively, involved in furnishing each qualified IDR item or service;
H The identity for each plan or issuer, and provider or facility, with respect to the notification. Specifically, each certified IDR entity must provide each partys name and address, as applicable; and I For each determination, the number of business days elapsed between selection of the certified IDR
entity and the determination of the outof-network rate by the certified IDR
entity.
vi The total amount of certified IDR
entity fees paid to the certified IDR
entity under paragraph d1 of this section during the month.
2 Reserved g Extension of time periods for extenuating circumstances1 General.
The time periods specified in this section other than the time for payment, if applicable, under paragraph c4ix of this section may be extended in extenuating circumstances at the Secretarys discretion if:
i An extension is necessary to address delays due to matters beyond the control of the parties or for good cause; and ii The parties attest that prompt action will be taken to ensure that the determination under this section is made as soon as administratively practicable under the circumstances.

E:FRFM07OCR2.SGM

07OCR2