Federal Register - October 7, 2021
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Source: Federal Register
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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
1 The alternative flat fee the certified IDR entity or IDR entity seeking certification believes is appropriate for the certified IDR entity or IDR entity seeking certification to charge;
2 A description of the circumstances that require the alternative fee; and 3 A description of how the alternative flat rate will be used to mitigate the effects of these circumstances; and B Receive from the Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor written approval to charge the fee documented in the certified IDR entitys or the IDR entity seeking certifications written proposal.
viii Have a procedure in place to retain the certified IDR entity fees described in paragraph d1 of this section paid by both parties in a trust or escrow account and to return the certified IDR entity fee paid by the prevailing party of an IDR payment determination, or half of each partys certified IDR entity fee in the case of an agreement described in paragraph c2i of this section, within 30
business days following the date of the determination;
ix Have a procedure in place to retain the administrative fees described in paragraph d2 of this section and to remit the administrative fees to the Secretary in accordance with the timeframe and procedures set forth in guidance published by the Secretary;
x Discharge its responsibilities in accordance with paragraph c of this section, including not making any determination with respect to which the certified IDR entity would not be eligible for selection pursuant to paragraph c1 of this section; and xi Collect the information required to be reported to the Secretary under paragraph f of this section and report the information on a timely basis in the form and manner provided in guidance published by the Secretary.
3 Conflict-of-interest standards. In addition to the general standards set forth in paragraph e2iv of this section, an IDR entity must provide written documentation that the IDR
entity satisfies the standards to be a certified IDR entity under this paragraph e3.
i The IDR entity must provide an attestation indicating that it does not have a conflict of interest as defined in paragraph a2 of this section;
ii The IDR entity must have procedures in place to ensure that personnel assigned to a determination do not have any conflicts of interest regarding any party to the dispute within the 1 year immediately preceding an assignment of dispute
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determination, similar to the requirements laid out in 18 U.S.C.
207b. In order to satisfy this requirement, if certified, the IDR entity must ensure that any personnel assigned to a determination do not have any conflicts of interest as defined in paragraph a2 of this section.
iii Following certification under this paragraph e, if a certified IDR entity acquires control of, becomes controlled by, or comes under common control with any entity described in paragraph e3i of this section, the certified IDR
entity must notify the Secretary in writing no later than 3 business days after the acquisition or exercise of control and shall be subject to the revocation of certification under paragraph e6ii of this section.
4 Period of certification. Subject to paragraphs e5 and 6 of this section, each certification including a recertification of a certified IDR entity under the process described in paragraph e1 of this section will be effective for a 5-year period.
5 Petition for denial or revocation i In general. An individual, provider, facility, provider of air ambulance services, plan, or issuer may petition for a denial of a certification for an IDR
entity or a revocation of a certification for a certified IDR entity for failure to meet a requirement of this section using the standard form and manner set forth in guidance to be issued by the Secretary. The petition for denial of a certification must be submitted within the timeframe set forth in guidance issued by the Secretary.
ii Content of petition. The individual, provider, facility, provider of air ambulance services, plan, or issuer seeking denial or revocation of certification must submit a written petition using the standard form issued by the Secretary including the following information:
A The identity of the IDR entity seeking certification or certified IDR
entity that is the subject of the petition;
B The reasons for the petition;
C Whether the petition seeks denial or revocation of a certification;
D Documentation to support the reasons outlined in the petition; and E Other information as may be required by the Secretary.
iii Process. A The Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor will acknowledge receipt of the petition within 10
business days of receipt of the petition.
B If the Secretary finds that the petition adequately shows a failure of the IDR entity seeking certification or the certified IDR entity to follow the requirements of this paragraph e, the
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Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, will notify the IDR entity seeking certification or the certified IDR entity by providing a de-identified copy of the petition. Following the notification, the IDR entity seeking certification or certified IDR entity will have 10
business days to provide a response.
After the time period for providing the response has passed, the Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, will review the response if any, determine whether a denial or revocation of a certification is warranted, and issue a notice of the decision to the IDR entity or certified IDR entity and to the petitioner. This decision will be subject to the appeal requirements of paragraph e6v of this section.
C Effect on certification under petition. Regarding a petition for revocation of a certified IDR entitys certification, if the Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, finds that the petition adequately shows a failure to comply with the requirements of this paragraph e, following the Secretarys notification of the failure to the certified IDR entity under paragraph e5iiiB
of this section, the certified IDR entity may continue to work on previously assigned determinations but may not accept new determinations until the Secretary issues a notice of the decision to the certified IDR entity finding that a revocation of certification is not warranted.
6 Denial of IDR entity certification or revocation of certified IDR entity certificationi Denial of IDR entity certification. The Secretary, jointly with the Secretary of the Treasury and the Secretary of Labor, may deny the certification of an IDR entity under paragraph e1 of this section if, during the process of certification, including as a result of a petition described in paragraph e5 of this section, the Secretary determines the following:
A The IDR entity fails to meet the applicable standards set forth under this paragraph e;
B The IDR entity has committed or participated in fraudulent or abusive activities, including, during the certification process, submitting fraudulent data, or submitting information or data the IDR entity knows to be false to the Secretary, the Secretary of the Treasury or the Secretary of Labor;
C The IDR entity has failed to comply with requests for information from the Secretary, the Secretary of the
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