(B) with respect to a reporting period for reason of significant hardship (as determined by the Secretary). (D) Authority to modify cost reporting elements and enforcement Not earlier than January 1, 2023, the Secretary may, after taking into account the recommendation of the Medicare Payment Advisory Commission in the most recent report available to the Secretary submitted under section 3 of the Ambulance Medicare Budget and Operations Act of 2017 regarding whether cost reporting of ground ambulance services by a supplier or category of suppliers (as specified for purposes of the report submitted under such section) should be required or modified, and through notice and comment rulemaking, provide that subparagraph (A) no longer applies to ground ambulance services suppliers or such a category of such suppliers. . (f) Stakeholder feedback (1) In general The Secretary shall implement the provisions of this section, including the amendments made by this section, through notice and comment rulemaking and seek input from stakeholders. (2) Nonapplication of Paperwork Reduction Act Chapter 35 of title 44, United States Code, shall not apply with respect to notice and comment rulemaking carried out under paragraph (1). 3. Ground ambulance services cost reporting study (a) In general Not later than March 15, 2022, and as determined necessary by the Medicare Payment Advisory Commission thereafter, such Commission shall assess and submit to Congress a report on ambulance services cost reporting carried out in accordance with sections 1121(a) and 1834(l) of the Social Security Act ( 42 U.S.C. 1320a(a) , 1395m(l)) and the adequacy of payments for such services made under section 1834(l) of such Act. (b) Contents The report described in subsection (a) shall contain the following: (1) An analysis of the accuracy of cost report data submitted in accordance with such sections. (2) An analysis of any burden on providers and suppliers of such services associated with reporting such data. (3) A recommendation on whether or not