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For the OPPS, section 1833(t)(2)(D) of the Act requires the Secretary to determine a wage adjustment factor to adjust the portion of payment and coinsurance attributable to labor-related costs for relative differences in labor and labor-related costs across geographic regions in a budget neutral manner

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Many of these new substances appear so fast and with little efficacy support in the literature making it difficult for anti-doping authorities to properly evaluate and consider if they are a problem from the standpoint of performance enhancement