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We note that all individual measures comprising the Safety of Care group are already risk adjusted for clinical factors at the measure level prior to reporting, and thus such differences are already implicitly factored into the Safety of Care measure group score

Specifically, we proposed updating the regulations at 419.46(e)(1), 419.95(g)(1), and 416.310(d)(1) to state that CMS may grant an ECE with respect to reporting requirements in the event of an extraordinary circumstancedefined as an event beyond the control of a hospital, REH, or ASC (for example, a natural or man-made disaster such as a hurricane, tornado, earthquake, terrorist attack, or bombing)that affected the ability of the hospital, REH, or ASC to comply with one or more applicable ( reporting requirements with respect to a calendar year

Response: We thank the commenter for the input

Daily supplementation provides steady tissue levels