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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
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h2 of this sectionHHS will communicate with the state and determine whether such process meets or exceeds such requirements. HHS will notify the state in writing of such determination.
4 HHS review of State process. HHS
will review changes to the State process on an annual basis or at other times if HHS receives information from the state that would indicate the state process no longer meets the minimum Federal requirements to ensure the state process continues to meet or exceed the minimum Federal standards set forth in this section.
5 State process termination. In the event that the State process is terminated, or HHS determines that the State process no longer meets the minimum Federal requirements described in paragraph h2 of this section, HHS will make the Federal process available to uninsured or self-

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pay individuals in that State to ensure that the states residents have access to a patient-provider dispute resolution process that meets the minimum Federal requirements.
i Extension of time periods for extenuating circumstances1 In general. The time periods specified in this section other than the time for payment of the administrative fees under paragraph d2 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.
2 Process to request an extension.
The time periods specified in this
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section may be extended in the case of extenuating circumstances at HHS
discretion. The parties may request an extension by submitting a request for extension due to extenuating circumstances through the Federal IDR
portal, or electronic or paper mail if the extension is necessary to address delays due to matters beyond the control of the parties or for good cause.
j Applicability date. The provisions of this section are applicable to uninsured or self-pay individuals;
providers including providers of air ambulance services and facilities; and SDR entities, generally beginning on or after January 1, 2022. The provisions regarding SDR entity certification in paragraphs a and d of this section, are applicable beginning on October 7, 2021.
FR Doc. 202121441 Filed 93021; 4:15 pm BILLING CODE 451029P

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