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Different lifestyle risk factors for oral cancer were discussed by Petti 20 but ETS was not included in that extensive review

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It reduces life expectancy, weakens the immune system, and contributes to poor quality of life

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The impact of assigning these beneficiaries to a CMS Innovation Center model notwithstanding their voluntary designation would be minimal because so few beneficiaries would be impacted by this proposed expansion of the exception (for PY 2024, less than 1 percent of all beneficiaries who voluntarily align to a Shared Savings Program ACO)