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However, as we stated in the CY 2023 HH PPS final rule (87 FR 66807) and the CY 2024 HH PPS final rule (88 FR 77695), Medicare does not set payments to cross-subsidize other payers, as we are mindful of our obligation to be responsible stewards of the Medicare Trust Funds

Air pollution and tobacco use, for that matter is not distributed equally around the world

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The present state and municipal regulations that exempt some people (for example military members) are now preempted by this federal legislation that does not include such exemptions