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We finally note, in the absence of the proposed policies discussed in section III.G.1 of this proposed rule (to include hospitals with 412.103 reclassification along with geographically rural hospitals in all rural wage index calculations, and to only exclude dual reclass hospitals (hospitals with simultaneous 412.103 and MGCRB reclassifications) when implicated by the hold harmless provision at section 1886(d)(8)(C)(ii) of the Act), the reclassification budget neutrality factor would be 0.985756

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Giannetta B, Plaza C, Cassetta M, Mariotto G, Benavente-Ferraces I, Garca-Gil JC, Panettieri M, Zaccone C (2023) The effects of biochar on soil organic matter pools are not influenced by climate change