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and a study by Caramello et al

For purposes of this cost measure exclusion policy at 414.1380(b)(2)(v)(B), we proposed to define significant changes or errors as changes or errors external to the care provided, and that CMS determines may lead to misleading or inaccurate results that negatively impact the measure's ability to reliably assess performance (89 FR 62088)

At a recent FDA meeting, the industry argued for expanding the federal definition of supplements to permit the use of newer ingredients such as peptides in their products