necessary to continue and stabilize programs into the extension period and shall work with the Secretary of Health and Human Services to implement such changes. (2) Notwithstanding the foregoing, the State may request, and the Secretary of Health and Human Services may approve, modifications to a demonstration project’s terms and conditions to address the impact of the federally designated public health emergency with respect to COVID–19. Such modifications may, at the option of the State, become effective retroactive to the start of the calendar quarter in which the first day of the emergency period described in paragraph (1)(B) of section 1135(g) of the Social Security Act ( 42 U.S.C. 1320b–5(g) ) occurs. (d) Budget neutrality Budget neutrality for extensions under this section shall be deemed to have been met at the conclusion of the extension period, and States receiving extensions under this section shall not be required to submit a budget neutrality analysis for the extension period. (e) Expedited application process The Federal and State public notice and comment procedures or other time constraints otherwise applicable to demonstration project amendments shall be waived to expedite a State’s extension request pursuant to this section. The Secretary of Health and Human Services shall approve the extension application within 45 days of a State’s submission of its request, or such other timeframe as is mutually agreed to with the State. (f) Continuation of secretarial authority under declared emergency This section does not restrict the Secretary of Health and Human Services from exercising existing flexibilities through demonstration projects operated pursuant to section 1115 of the Social Security Act ( 42 U.S.C. 1315 ) in conjunction with the COVID–19 public health emergency. (g) Rule of construction Nothing in this section shall authorize the Secretary of Health and Human Service to approve or extend a waiver that fails to meet the requirements of section 1115 of the Social Security Act ( 42 U.S.C. 1315