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We note that out of the 32 hospital-based EDs that were tested for reliability, validity, and feasibility, approximately 20 percent were rural EDs, although not in the REHQR Program

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Comment: Many commenters reiterated their longstanding recommendation that CMS discontinue the ASC weight scalar, stating that the secondary rescaling process applied to maintain budget neutrality has created an inappropriate and growing payment disparity between ASCs and HOPDs, with ASC reimbursement rates now averaging 50 percent less than HOPD rates for the same procedures despite no evidence of increased differences in capital and operating costs between settings