{"abstract":"This final rule with comment period updates the home health prospective payment system (HH PPS) payment rates and wage index for CY 2020; implements the Patient-Driven Groupings Model (PDGM), a revised case-mix adjustment methodology, for home health services beginning on or after January 1, 2020. This final rule with comment period also implements a change in the unit of payment from 60-day episodes of care to 30-day periods of care, as required by section 51001 of the Bipartisan Budget Act of 2018, hereinafter referred to the \"BBA of 2018\", and finalizes a 30-day payment amount for CY 2020. Additionally, this final rule with comment period: Modifies the payment regulations pertaining to the content of the home health plan of care; allows therapist assistants to furnish maintenance therapy; and changes the split percentage payment approach under the HH PPS. For the Home Health Value-Based Purchasing (HHVBP) model, we are finalizing provisions requiring the public reporting of the Total Performance Score (TPS) and the TPS Percentile Ranking from the Performance Year 5 (CY 2020) Annual TPS and Payment Adjustment Report for each home health agency in the nine Model states that qualified for a payment adjustment for CY 2020. This final rule with comment period also finalizes the following updates to the Home Health Quality Reporting Program (HH QRP): Removal of a measure; adoption of two new measures; modification of an existing measure; and a requirement for HHA's to report standardized patient assessment data beginning with the CY 2022 HH QRP. Additionally, we are finalizing our proposal to re-designate our current HH QRP regulations in a different section of our regulations and to codify other current policies in that new regulatory section with one substantive change as well as a few technical edits. We are not finalizing our proposal to remove question 10 from all of the HH Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Lastly, it sets forth routine updates to the home infusion therapy payment rates for CY 2020, payment provisions for home infusion therapy services for CY 2021 and subsequent years, and solicits comments on options to enhance future efforts to improve policies related to coverage of eligible drugs for home infusion therapy.","action":"Final rule with comment period.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2019/11/08/2019-24026.html","cfr_references":[{"chapter":null,"citation_url":null,"part":409,"title":42},{"chapter":null,"citation_url":null,"part":414,"title":42},{"chapter":null,"citation_url":null,"part":484,"title":42},{"chapter":null,"citation_url":null,"part":486,"title":42}],"citation":"84 FR 60478","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective Date: This final rule with comment period is effective January 1, 2020.","disposition_notes":null,"docket_ids":["CMS-1711-FC"],"dockets":[],"document_number":"2019-24026","effective_on":null,"end_page":60646,"executive_order_notes":null,"executive_order_number":null,"explanation":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2019/11/08/2019-24026.xml","html_url":"https://www.federalregister.gov/documents/2019/11/08/2019-24026/medicare-and-medicaid-programs-cy-2020-home-health-prospective-payment-system-rate-update-home","images":{"ER08NO19.042":{"large":"https://img.federalregister.gov/ER08NO19.042/ER08NO19.042_large.png","original_size":"https://img.federalregister.gov/ER08NO19.042/ER08NO19.042_original_size.png"},"ER08NO19.043":{"large":"https://img.federalregister.gov/ER08NO19.043/ER08NO19.043_large.png","original_size":"https://img.federalregister.gov/ER08NO19.043/ER08NO19.043_original_size.png"},"ER08NO19.040":{"large":"https://img.federalregister.gov/ER08NO19.040/ER08NO19.040_large.png","original_size":"https://img.federalregister.gov/ER08NO19.040/ER08NO19.040_original_size.png"},"ER08NO19.041":{"large":"https://img.federalregister.gov/ER08NO19.041/ER08NO19.041_large.png","original_size":"https://img.federalregister.gov/ER08NO19.041/ER08NO19.041_original_size.png"},"ER08NO19.039":{"large":"https://img.federalregister.gov/ER08NO19.039/ER08NO19.039_large.png","original_size":"https://img.federalregister.gov/ER08NO19.039/ER08NO19.039_original_size.png"},"ER08NO19.037":{"large":"https://img.federalregister.gov/ER08NO19.037/ER08NO19.037_large.png","original_size":"https://img.federalregister.gov/ER08NO19.037/ER08NO19.037_original_size.png"},"ER08NO19.038":{"large":"https://img.federalregister.gov/ER08NO19.038/ER08NO19.038_large.png","original_size":"https://img.federalregister.gov/ER08NO19.038/ER08NO19.038_original_size.png"},"ER08NO19.035":{"large":"https://img.federalregister.gov/ER08NO19.035/ER08NO19.035_large.png","original_size":"https://img.federalregister.gov/ER08NO19.035/ER08NO19.035_original_size.png"},"ER08NO19.036":{"large":"https://img.federalregister.gov/ER08NO19.036/ER08NO19.036_large.png","original_size":"https://img.federalregister.gov/ER08NO19.036/ER08NO19.036_original_size.png"},"ER08NO19.033":{"large":"https://img.federalregister.gov/ER08NO19.033/ER08NO19.033_large.png","original_size":"https://img.federalregister.gov/ER08NO19.033/ER08NO19.033_original_size.png"},"ER08NO19.034":{"large":"https://img.federalregister.gov/ER08NO19.034/ER08NO19.034_large.png","original_size":"https://img.federalregister.gov/ER08NO19.034/ER08NO19.034_original_size.png"},"ER08NO19.053":{"large":"https://img.federalregister.gov/ER08NO19.053/ER08NO19.053_large.png","original_size":"https://img.federalregister.gov/ER08NO19.053/ER08NO19.053_original_size.png"},"ER08NO19.010":{"large":"https://img.federalregister.gov/ER08NO19.010/ER08NO19.010_large.png","original_size":"https://img.federalregister.gov/ER08NO19.010/ER08NO19.010_original_size.png"},"ER08NO19.054":{"large":"https://img.federalregister.gov/ER08NO19.054/ER08NO19.054_large.png","original_size":"https://img.federalregister.gov/ER08NO19.054/ER08NO19.054_original_size.png"},"ER08NO19.051":{"large":"https://img.federalregister.gov/ER08NO19.051/ER08NO19.051_large.png","original_size":"https://img.federalregister.gov/ER08NO19.051/ER08NO19.051_original_size.png"},"ER08NO19.052":{"large":"https://img.federalregister.gov/ER08NO19.052/ER08NO19.052_large.png","original_size":"https://img.federalregister.gov/ER08NO19.052/ER08NO19.052_original_size.png"},"ER08NO19.050":{"large":"https://img.federalregister.gov/ER08NO19.050/ER08NO19.050_large.png","original_size":"https://img.federalregister.gov/ER08NO19.050/ER08NO19.050_original_size.png"},"ER08NO19.008":{"large":"https://img.federalregister.gov/ER08NO19.008/ER08NO19.008_large.png","original_size":"https://img.federalregister.gov/ER08NO19.008/ER08NO19.008_original_size.png"},"ER08NO19.009":{"large":"https://img.federalregister.gov/ER08NO19.009/ER08NO19.009_large.png","original_size":"https://img.federalregister.gov/ER08NO19.009/ER08NO19.009_original_size.png"},"ER08NO19.006":{"large":"https://img.federalregister.gov/ER08NO19.006/ER08NO19.006_large.png","original_size":"https://img.federalregister.gov/ER08NO19.006/ER08NO19.006_original_size.png"},"ER08NO19.007":{"large":"https://img.federalregister.gov/ER08NO19.007/ER08NO19.007_large.png","original_size":"https://img.federalregister.gov/ER08NO19.007/ER08NO19.007_original_size.png"},"ER08NO19.004":{"large":"https://img.federalregister.gov/ER08NO19.004/ER08NO19.004_large.png","original_size":"https://img.federalregister.gov/ER08NO19.004/ER08NO19.004_original_size.png"},"ER08NO19.048":{"large":"https://img.federalregister.gov/ER08NO19.048/ER08NO19.048_large.png","original_size":"https://img.federalregister.gov/ER08NO19.048/ER08NO19.048_original_size.png"},"ER08NO19.005":{"large":"https://img.federalregister.gov/ER08NO19.005/ER08NO19.005_large.png","original_size":"https://img.federalregister.gov/ER08NO19.005/ER08NO19.005_original_size.png"},"ER08NO19.049":{"large":"https://img.federalregister.gov/ER08NO19.049/ER08NO19.049_large.png","original_size":"https://img.federalregister.gov/ER08NO19.049/ER08NO19.049_original_size.png"},"ER08NO19.002":{"large":"https://img.federalregister.gov/ER08NO19.002/ER08NO19.002_large.png","original_size":"https://img.federalregister.gov/ER08NO19.002/ER08NO19.002_original_size.png"},"ER08NO19.046":{"large":"https://img.federalregister.gov/ER08NO19.046/ER08NO19.046_large.png","original_size":"https://img.federalregister.gov/ER08NO19.046/ER08NO19.046_original_size.png"},"ER08NO19.003":{"large":"https://img.federalregister.gov/ER08NO19.003/ER08NO19.003_large.png","original_size":"https://img.federalregister.gov/ER08NO19.003/ER08NO19.003_original_size.png"},"ER08NO19.047":{"large":"https://img.federalregister.gov/ER08NO19.047/ER08NO19.047_large.png","original_size":"https://img.federalregister.gov/ER08NO19.047/ER08NO19.047_original_size.png"},"ER08NO19.000":{"large":"https://img.federalregister.gov/ER08NO19.000/ER08NO19.000_large.png","original_size":"https://img.federalregister.gov/ER08NO19.000/ER08NO19.000_original_size.png"},"ER08NO19.044":{"large":"https://img.federalregister.gov/ER08NO19.044/ER08NO19.044_large.png","original_size":"https://img.federalregister.gov/ER08NO19.044/ER08NO19.044_original_size.png"},"ER08NO19.001":{"large":"https://img.federalregister.gov/ER08NO19.001/ER08NO19.001_large.png","original_size":"https://img.federalregister.gov/ER08NO19.001/ER08NO19.001_original_size.png"},"ER08NO19.045":{"large":"https://img.federalregister.gov/ER08NO19.045/ER08NO19.045_large.png","original_size":"https://img.federalregister.gov/ER08NO19.045/ER08NO19.045_original_size.png"},"ER08NO19.020":{"large":"https://img.federalregister.gov/ER08NO19.020/ER08NO19.020_large.png","original_size":"https://img.federalregister.gov/ER08NO19.020/ER08NO19.020_original_size.png"},"ER08NO19.021":{"large":"https://img.federalregister.gov/ER08NO19.021/ER08NO19.021_large.png","original_size":"https://img.federalregister.gov/ER08NO19.021/ER08NO19.021_original_size.png"},"ER08NO19.019":{"large":"https://img.federalregister.gov/ER08NO19.019/ER08NO19.019_large.png","original_size":"https://img.federalregister.gov/ER08NO19.019/ER08NO19.019_original_size.png"},"ER08NO19.017":{"large":"https://img.federalregister.gov/ER08NO19.017/ER08NO19.017_large.png","original_size":"https://img.federalregister.gov/ER08NO19.017/ER08NO19.017_original_size.png"},"ER08NO19.018":{"large":"https://img.federalregister.gov/ER08NO19.018/ER08NO19.018_large.png","original_size":"https://img.federalregister.gov/ER08NO19.018/ER08NO19.018_original_size.png"},"ER08NO19.015":{"large":"https://img.federalregister.gov/ER08NO19.015/ER08NO19.015_large.png","original_size":"https://img.federalregister.gov/ER08NO19.015/ER08NO19.015_original_size.png"},"ER08NO19.016":{"large":"https://img.federalregister.gov/ER08NO19.016/ER08NO19.016_large.png","original_size":"https://img.federalregister.gov/ER08NO19.016/ER08NO19.016_original_size.png"},"ER08NO19.013":{"large":"https://img.federalregister.gov/ER08NO19.013/ER08NO19.013_large.png","original_size":"https://img.federalregister.gov/ER08NO19.013/ER08NO19.013_original_size.png"},"ER08NO19.057":{"large":"https://img.federalregister.gov/ER08NO19.057/ER08NO19.057_large.png","original_size":"https://img.federalregister.gov/ER08NO19.057/ER08NO19.057_original_size.png"},"ER08NO19.014":{"large":"https://img.federalregister.gov/ER08NO19.014/ER08NO19.014_large.png","original_size":"https://img.federalregister.gov/ER08NO19.014/ER08NO19.014_original_size.png"},"ER08NO19.058":{"large":"https://img.federalregister.gov/ER08NO19.058/ER08NO19.058_large.png","original_size":"https://img.federalregister.gov/ER08NO19.058/ER08NO19.058_original_size.png"},"ER08NO19.011":{"large":"https://img.federalregister.gov/ER08NO19.011/ER08NO19.011_large.png","original_size":"https://img.federalregister.gov/ER08NO19.011/ER08NO19.011_original_size.png"},"ER08NO19.055":{"large":"https://img.federalregister.gov/ER08NO19.055/ER08NO19.055_large.png","original_size":"https://img.federalregister.gov/ER08NO19.055/ER08NO19.055_original_size.png"},"ER08NO19.012":{"large":"https://img.federalregister.gov/ER08NO19.012/ER08NO19.012_large.png","original_size":"https://img.federalregister.gov/ER08NO19.012/ER08NO19.012_original_size.png"},"ER08NO19.056":{"large":"https://img.federalregister.gov/ER08NO19.056/ER08NO19.056_large.png","original_size":"https://img.federalregister.gov/ER08NO19.056/ER08NO19.056_original_size.png"},"ER08NO19.031":{"large":"https://img.federalregister.gov/ER08NO19.031/ER08NO19.031_large.png","original_size":"https://img.federalregister.gov/ER08NO19.031/ER08NO19.031_original_size.png"},"ER08NO19.032":{"large":"https://img.federalregister.gov/ER08NO19.032/ER08NO19.032_large.png","original_size":"https://img.federalregister.gov/ER08NO19.032/ER08NO19.032_original_size.png"},"ER08NO19.030":{"large":"https://img.federalregister.gov/ER08NO19.030/ER08NO19.030_large.png","original_size":"https://img.federalregister.gov/ER08NO19.030/ER08NO19.030_original_size.png"},"ER08NO19.028":{"large":"https://img.federalregister.gov/ER08NO19.028/ER08NO19.028_large.png","original_size":"https://img.federalregister.gov/ER08NO19.028/ER08NO19.028_original_size.png"},"ER08NO19.029":{"large":"https://img.federalregister.gov/ER08NO19.029/ER08NO19.029_large.png","original_size":"https://img.federalregister.gov/ER08NO19.029/ER08NO19.029_original_size.png"},"ER08NO19.026":{"large":"https://img.federalregister.gov/ER08NO19.026/ER08NO19.026_large.png","original_size":"https://img.federalregister.gov/ER08NO19.026/ER08NO19.026_original_size.png"},"ER08NO19.103":{"large":"https://img.federalregister.gov/ER08NO19.103/ER08NO19.103_large.png","original_size":"https://img.federalregister.gov/ER08NO19.103/ER08NO19.103_original_size.png"},"ER08NO19.027":{"large":"https://img.federalregister.gov/ER08NO19.027/ER08NO19.027_large.png","original_size":"https://img.federalregister.gov/ER08NO19.027/ER08NO19.027_original_size.png"},"ER08NO19.024":{"large":"https://img.federalregister.gov/ER08NO19.024/ER08NO19.024_large.png","original_size":"https://img.federalregister.gov/ER08NO19.024/ER08NO19.024_original_size.png"},"ER08NO19.025":{"large":"https://img.federalregister.gov/ER08NO19.025/ER08NO19.025_large.png","original_size":"https://img.federalregister.gov/ER08NO19.025/ER08NO19.025_original_size.png"},"ER08NO19.022":{"large":"https://img.federalregister.gov/ER08NO19.022/ER08NO19.022_large.png","original_size":"https://img.federalregister.gov/ER08NO19.022/ER08NO19.022_original_size.png"},"ER08NO19.023":{"large":"https://img.federalregister.gov/ER08NO19.023/ER08NO19.023_large.png","original_size":"https://img.federalregister.gov/ER08NO19.023/ER08NO19.023_original_size.png"}},"images_metadata":{"ER08NO19.042":{"large":{"identifier":"ER08NO19.042","content_type":"image/png","size":21492,"width":823,"sha":"7b2f6f6266fd039dba8f48f250fb92e7","url":"https://img.federalregister.gov/ER08NO19.042/ER08NO19.042_large.png","height":203},"original_size":{"identifier":"ER08NO19.042","content_type":"image/png","size":37619,"width":3680,"sha":"2743f633f4a92144245e7186e69a9312","url":"https://img.federalregister.gov/ER08NO19.042/ER08NO19.042_original_size.png","height":908}},"ER08NO19.043":{"large":{"identifier":"ER08NO19.043","content_type":"image/png","size":33802,"width":822,"sha":"2a35d4cb8462d4ad0de53d7a13344411","url":"https://img.federalregister.gov/ER08NO19.043/ER08NO19.043_large.png","height":331},"original_size":{"identifier":"ER08NO19.043","content_type":"image/png","size":53931,"width":3686,"sha":"641492653248328c55e153267f9128cc","url":"https://img.federalregister.gov/ER08NO19.043/ER08NO19.043_original_size.png","height":1485}},"ER08NO19.040":{"large":{"identifier":"ER08NO19.040","content_type":"image/png","size":25830,"width":821,"sha":"531f61784048ff6cad2392bb633d779e","url":"https://img.federalregister.gov/ER08NO19.040/ER08NO19.040_large.png","height":345},"original_size":{"identifier":"ER08NO19.040","content_type":"image/png","size":35841,"width":3261,"sha":"845f6efd7e0eeaff2016a642a49a83dc","url":"https://img.federalregister.gov/ER08NO19.040/ER08NO19.040_original_size.png","height":1370}},"ER08NO19.041":{"large":{"identifier":"ER08NO19.041","content_type":"image/png","size":18971,"width":822,"sha":"31f7d58f50c1db4041fe6b2c2bdac8b4","url":"https://img.federalregister.gov/ER08NO19.041/ER08NO19.041_large.png","height":179},"original_size":{"identifier":"ER08NO19.041","content_type":"image/png","size":30385,"width":3642,"sha":"e7771adc30b0b5f92b020ab38f39010f","url":"https://img.federalregister.gov/ER08NO19.041/ER08NO19.041_original_size.png","height":793}},"ER08NO19.039":{"large":{"identifier":"ER08NO19.039","content_type":"image/png","size":19328,"width":823,"sha":"47386dd1bbf64eb2e2fb90b02c5b8486","url":"https://img.federalregister.gov/ER08NO19.039/ER08NO19.039_large.png","height":224},"original_size":{"identifier":"ER08NO19.039","content_type":"image/png","size":27201,"width":3261,"sha":"8fcce2e1111e8883c1003098844d4bef","url":"https://img.federalregister.gov/ER08NO19.039/ER08NO19.039_original_size.png","height":889}},"ER08NO19.037":{"large":{"identifier":"ER08NO19.037","content_type":"image/png","size":13071,"width":781,"sha":"7e3fa217ecd7f27d26a06db02e268a8f","url":"https://img.federalregister.gov/ER08NO19.037/ER08NO19.037_large.png","height":158},"original_size":{"identifier":"ER08NO19.037","content_type":"image/png","size":16684,"width":2778,"sha":"10dfc46857bf5e623b0c464ab2ae0a23","url":"https://img.federalregister.gov/ER08NO19.037/ER08NO19.037_original_size.png","height":563}},"ER08NO19.038":{"large":{"identifier":"ER08NO19.038","content_type":"image/png","size":19592,"width":823,"sha":"b0d746e9f640c0ed0adb949d624902b3","url":"https://img.federalregister.gov/ER08NO19.038/ER08NO19.038_large.png","height":257},"original_size":{"identifier":"ER08NO19.038","content_type":"image/png","size":29693,"width":3341,"sha":"82f377af37e1a8c63517afc3e8992efc","url":"https://img.federalregister.gov/ER08NO19.038/ER08NO19.038_original_size.png","height":1043}},"ER08NO19.035":{"large":{"identifier":"ER08NO19.035","content_type":"image/png","size":17944,"width":823,"sha":"74ea798233fa105ff9e9d5d7bea0fa26","url":"https://img.federalregister.gov/ER08NO19.035/ER08NO19.035_large.png","height":199},"original_size":{"identifier":"ER08NO19.035","content_type":"image/png","size":31252,"width":3755,"sha":"8c2b2715c7b57d02aaa07ca5725801de","url":"https://img.federalregister.gov/ER08NO19.035/ER08NO19.035_original_size.png","height":908}},"ER08NO19.036":{"large":{"identifier":"ER08NO19.036","content_type":"image/png","size":22675,"width":823,"sha":"cc22c4d1878a1810b2d88d610cec153d","url":"https://img.federalregister.gov/ER08NO19.036/ER08NO19.036_large.png","height":222},"original_size":{"identifier":"ER08NO19.036","content_type":"image/png","size":38621,"width":3791,"sha":"b6e3af64924d52ebab4b84b591b117ac","url":"https://img.federalregister.gov/ER08NO19.036/ER08NO19.036_original_size.png","height":1023}},"ER08NO19.033":{"large":{"identifier":"ER08NO19.033","content_type":"image/png","size":90013,"width":823,"sha":"f7f41e2b18adab42036c67090955f017","url":"https://img.federalregister.gov/ER08NO19.033/ER08NO19.033_large.png","height":1058},"original_size":{"identifier":"ER08NO19.033","content_type":"image/png","size":158061,"width":4149,"sha":"9bb89e402489a8c4a317898ce50757b6","url":"https://img.federalregister.gov/ER08NO19.033/ER08NO19.033_original_size.png","height":5336}},"ER08NO19.034":{"large":{"identifier":"ER08NO19.034","content_type":"image/png","size":31781,"width":820,"sha":"dcc31005984171bae293ab2191223884","url":"https://img.federalregister.gov/ER08NO19.034/ER08NO19.034_large.png","height":317},"original_size":{"identifier":"ER08NO19.034","content_type":"image/png","size":59545,"width":4149,"sha":"2276b8f72b4c9032206e45723fbbaabc","url":"https://img.federalregister.gov/ER08NO19.034/ER08NO19.034_original_size.png","height":1604}},"ER08NO19.053":{"large":{"identifier":"ER08NO19.053","content_type":"image/png","size":73123,"width":823,"sha":"28f35c7afd37a8c3f7ccd7e6bc00a340","url":"https://img.federalregister.gov/ER08NO19.053/ER08NO19.053_large.png","height":674},"original_size":{"identifier":"ER08NO19.053","content_type":"image/png","size":157027,"width":4428,"sha":"6213365f569317a6c1ec944d5a210438","url":"https://img.federalregister.gov/ER08NO19.053/ER08NO19.053_original_size.png","height":3627}},"ER08NO19.010":{"large":{"identifier":"ER08NO19.010","content_type":"image/png","size":40366,"width":823,"sha":"f5872699b083a1ba086e5cb85c06b3e6","url":"https://img.federalregister.gov/ER08NO19.010/ER08NO19.010_large.png","height":394},"original_size":{"identifier":"ER08NO19.010","content_type":"image/png","size":73099,"width":4015,"sha":"0646edceaacc78fd45920e5a3662e2ce","url":"https://img.federalregister.gov/ER08NO19.010/ER08NO19.010_original_size.png","height":1923}},"ER08NO19.054":{"large":{"identifier":"ER08NO19.054","content_type":"image/png","size":70689,"width":823,"sha":"c7cce65b75e98a4b614905bbea77f461","url":"https://img.federalregister.gov/ER08NO19.054/ER08NO19.054_large.png","height":714},"original_size":{"identifier":"ER08NO19.054","content_type":"image/png","size":167958,"width":4428,"sha":"31ab6cbc18f844c63efec6e0d68905be","url":"https://img.federalregister.gov/ER08NO19.054/ER08NO19.054_original_size.png","height":3840}},"ER08NO19.051":{"large":{"identifier":"ER08NO19.051","content_type":"image/png","size":19976,"width":823,"sha":"1d2dbe4fe5f7f2daf733cdad06f6ffa0","url":"https://img.federalregister.gov/ER08NO19.051/ER08NO19.051_large.png","height":174},"original_size":{"identifier":"ER08NO19.051","content_type":"image/png","size":39802,"width":4093,"sha":"1a24d770a0897c904e3358e900a03d5d","url":"https://img.federalregister.gov/ER08NO19.051/ER08NO19.051_original_size.png","height":863}},"ER08NO19.052":{"large":{"identifier":"ER08NO19.052","content_type":"image/png","size":24001,"width":823,"sha":"ff70a9c201b3e85c11a54390c75cf0e8","url":"https://img.federalregister.gov/ER08NO19.052/ER08NO19.052_large.png","height":269},"original_size":{"identifier":"ER08NO19.052","content_type":"image/png","size":44291,"width":3903,"sha":"404ec84fd59266956b50fbe147d3db59","url":"https://img.federalregister.gov/ER08NO19.052/ER08NO19.052_original_size.png","height":1275}},"ER08NO19.050":{"large":{"identifier":"ER08NO19.050","content_type":"image/png","size":2031,"width":352,"sha":"67c317be01d457a7dbef113fd9a7d987","url":"https://img.federalregister.gov/ER08NO19.050/ER08NO19.050_large.png","height":31},"original_size":{"identifier":"ER08NO19.050","content_type":"image/png","size":2814,"width":1272,"sha":"f5c747b4a6b132062239240a9dec1363","url":"https://img.federalregister.gov/ER08NO19.050/ER08NO19.050_original_size.png","height":112}},"ER08NO19.008":{"large":{"identifier":"ER08NO19.008","content_type":"image/png","size":49956,"width":821,"sha":"1b7ccd18e67e38dfbf5de9417a7bcdb2","url":"https://img.federalregister.gov/ER08NO19.008/ER08NO19.008_large.png","height":675},"original_size":{"identifier":"ER08NO19.008","content_type":"image/png","size":79973,"width":3988,"sha":"6db041da414bc742b5ec7f21669950e3","url":"https://img.federalregister.gov/ER08NO19.008/ER08NO19.008_original_size.png","height":3278}},"ER08NO19.009":{"large":{"identifier":"ER08NO19.009","content_type":"image/png","size":67820,"width":823,"sha":"c86f756e89d5cf8a4097659346eeff5a","url":"https://img.federalregister.gov/ER08NO19.009/ER08NO19.009_large.png","height":1305},"original_size":{"identifier":"ER08NO19.009","content_type":"image/png","size":99294,"width":3479,"sha":"ef3f959656ea455ea3381e9a37ba463f","url":"https://img.federalregister.gov/ER08NO19.009/ER08NO19.009_original_size.png","height":5518}},"ER08NO19.006":{"large":{"identifier":"ER08NO19.006","content_type":"image/png","size":48929,"width":822,"sha":"1c17ad8e9f727c602e8ea814101cf9d3","url":"https://img.federalregister.gov/ER08NO19.006/ER08NO19.006_large.png","height":388},"original_size":{"identifier":"ER08NO19.006","content_type":"image/png","size":157106,"width":4841,"sha":"e5a56bc05c7654c6c92c022fffc8c0f8","url":"https://img.federalregister.gov/ER08NO19.006/ER08NO19.006_original_size.png","height":2286}},"ER08NO19.007":{"large":{"identifier":"ER08NO19.007","content_type":"image/png","size":20911,"width":822,"sha":"e17e9c62e8e309683d566738ff4fbea8","url":"https://img.federalregister.gov/ER08NO19.007/ER08NO19.007_large.png","height":271},"original_size":{"identifier":"ER08NO19.007","content_type":"image/png","size":33495,"width":3801,"sha":"d1db39e3ce23276ce6d8e7cd6ab98d5e","url":"https://img.federalregister.gov/ER08NO19.007/ER08NO19.007_original_size.png","height":1253}},"ER08NO19.004":{"large":{"identifier":"ER08NO19.004","content_type":"image/png","size":29274,"width":823,"sha":"3021c957aae7eda24a9e744f0a08ae40","url":"https://img.federalregister.gov/ER08NO19.004/ER08NO19.004_large.png","height":266},"original_size":{"identifier":"ER08NO19.004","content_type":"image/png","size":51775,"width":4015,"sha":"9525ff2a4ee7f516b8116849c91b84b4","url":"https://img.federalregister.gov/ER08NO19.004/ER08NO19.004_original_size.png","height":1297}},"ER08NO19.048":{"large":{"identifier":"ER08NO19.048","content_type":"image/png","size":44031,"width":823,"sha":"c49d12c9ebe14b0e6f11e33b22af0c61","url":"https://img.federalregister.gov/ER08NO19.048/ER08NO19.048_large.png","height":324},"original_size":{"identifier":"ER08NO19.048","content_type":"image/png","size":231712,"width":4655,"sha":"73714f05f7d245b750f46407cf0c368e","url":"https://img.federalregister.gov/ER08NO19.048/ER08NO19.048_original_size.png","height":1833}},"ER08NO19.005":{"large":{"identifier":"ER08NO19.005","content_type":"image/png","size":55549,"width":823,"sha":"85722698d3606cf0c9362e1ff6bda543","url":"https://img.federalregister.gov/ER08NO19.005/ER08NO19.005_large.png","height":952},"original_size":{"identifier":"ER08NO19.005","content_type":"image/png","size":161790,"width":3336,"sha":"bd05d778e45b27b73ab49af568dd1f79","url":"https://img.federalregister.gov/ER08NO19.005/ER08NO19.005_original_size.png","height":3859}},"ER08NO19.049":{"large":{"identifier":"ER08NO19.049","content_type":"image/png","size":23812,"width":820,"sha":"e46741a729a9d57f9f3d870e049481db","url":"https://img.federalregister.gov/ER08NO19.049/ER08NO19.049_large.png","height":244},"original_size":{"identifier":"ER08NO19.049","content_type":"image/png","size":54914,"width":3980,"sha":"74f863bdf62d6fe2ccf65ca60d0c5c9d","url":"https://img.federalregister.gov/ER08NO19.049/ER08NO19.049_original_size.png","height":1185}},"ER08NO19.002":{"large":{"identifier":"ER08NO19.002","content_type":"image/png","size":26486,"width":823,"sha":"d613be4f29c50d069cb5375c908e1d29","url":"https://img.federalregister.gov/ER08NO19.002/ER08NO19.002_large.png","height":247},"original_size":{"identifier":"ER08NO19.002","content_type":"image/png","size":53536,"width":4315,"sha":"bc7b11b3e4cd6b15de3c98dcb6299918","url":"https://img.federalregister.gov/ER08NO19.002/ER08NO19.002_original_size.png","height":1297}},"ER08NO19.046":{"large":{"identifier":"ER08NO19.046","content_type":"image/png","size":40992,"width":823,"sha":"c85a59fa945dd20550974948f3350d07","url":"https://img.federalregister.gov/ER08NO19.046/ER08NO19.046_large.png","height":444},"original_size":{"identifier":"ER08NO19.046","content_type":"image/png","size":74736,"width":3901,"sha":"5e6168bd53ecc222992154c00fc4dbb7","url":"https://img.federalregister.gov/ER08NO19.046/ER08NO19.046_original_size.png","height":2105}},"ER08NO19.003":{"large":{"identifier":"ER08NO19.003","content_type":"image/png","size":43451,"width":823,"sha":"a260327bbb83efc2d41423651cbdfe7b","url":"https://img.federalregister.gov/ER08NO19.003/ER08NO19.003_large.png","height":369},"original_size":{"identifier":"ER08NO19.003","content_type":"image/png","size":114891,"width":4107,"sha":"0fb1804640613801b16f82f9a78eb2b3","url":"https://img.federalregister.gov/ER08NO19.003/ER08NO19.003_original_size.png","height":1842}},"ER08NO19.047":{"large":{"identifier":"ER08NO19.047","content_type":"image/png","size":77715,"width":822,"sha":"a29421888fcfa86afea0564da665ede6","url":"https://img.federalregister.gov/ER08NO19.047/ER08NO19.047_large.png","height":804},"original_size":{"identifier":"ER08NO19.047","content_type":"image/png","size":139256,"width":4015,"sha":"6c1bfb64958e3c5d6657160233b910fa","url":"https://img.federalregister.gov/ER08NO19.047/ER08NO19.047_original_size.png","height":3927}},"ER08NO19.000":{"large":{"identifier":"ER08NO19.000","content_type":"image/png","size":74331,"width":823,"sha":"4475d837d65fc52b85ddd2d5502f2d35","url":"https://img.federalregister.gov/ER08NO19.000/ER08NO19.000_large.png","height":758},"original_size":{"identifier":"ER08NO19.000","content_type":"image/png","size":137838,"width":4207,"sha":"4f7ad1a70200b4a587d62c36a54ede66","url":"https://img.federalregister.gov/ER08NO19.000/ER08NO19.000_original_size.png","height":3877}},"ER08NO19.044":{"large":{"identifier":"ER08NO19.044","content_type":"image/png","size":35674,"width":823,"sha":"db0369623d5f12e6e14eec2163ac7eca","url":"https://img.federalregister.gov/ER08NO19.044/ER08NO19.044_large.png","height":369},"original_size":{"identifier":"ER08NO19.044","content_type":"image/png","size":63774,"width":3828,"sha":"fce1a0394fcbe650243090538ab39005","url":"https://img.federalregister.gov/ER08NO19.044/ER08NO19.044_original_size.png","height":1716}},"ER08NO19.001":{"large":{"identifier":"ER08NO19.001","content_type":"image/png","size":46280,"width":822,"sha":"376c704c4bb6a9da25dd3a25782ef831","url":"https://img.federalregister.gov/ER08NO19.001/ER08NO19.001_large.png","height":362},"original_size":{"identifier":"ER08NO19.001","content_type":"image/png","size":221609,"width":4030,"sha":"99ef32d7666ef6aba796ad5283eaea35","url":"https://img.federalregister.gov/ER08NO19.001/ER08NO19.001_original_size.png","height":1774}},"ER08NO19.045":{"large":{"identifier":"ER08NO19.045","content_type":"image/png","size":77389,"width":823,"sha":"d6015fbce47a50fe8c6cbb3834364fc1","url":"https://img.federalregister.gov/ER08NO19.045/ER08NO19.045_large.png","height":682},"original_size":{"identifier":"ER08NO19.045","content_type":"image/png","size":219935,"width":4695,"sha":"b9202062142bf0a2aed219e40a0e9c66","url":"https://img.federalregister.gov/ER08NO19.045/ER08NO19.045_original_size.png","height":3890}},"ER08NO19.020":{"large":{"identifier":"ER08NO19.020","content_type":"image/png","size":39917,"width":823,"sha":"bf08c2a597c6fcb33ad20b43f774970c","url":"https://img.federalregister.gov/ER08NO19.020/ER08NO19.020_large.png","height":299},"original_size":{"identifier":"ER08NO19.020","content_type":"image/png","size":95868,"width":4307,"sha":"706b4f7a3474565a9a89565b0651a002","url":"https://img.federalregister.gov/ER08NO19.020/ER08NO19.020_original_size.png","height":1565}},"ER08NO19.021":{"large":{"identifier":"ER08NO19.021","content_type":"image/png","size":117531,"width":822,"sha":"e88a322d60e52a426ec0d29e15f15a88","url":"https://img.federalregister.gov/ER08NO19.021/ER08NO19.021_large.png","height":1138},"original_size":{"identifier":"ER08NO19.021","content_type":"image/png","size":200951,"width":3846,"sha":"20e75982ace830f7bdd2e79cebf8946f","url":"https://img.federalregister.gov/ER08NO19.021/ER08NO19.021_original_size.png","height":5324}},"ER08NO19.019":{"large":{"identifier":"ER08NO19.019","content_type":"image/png","size":90643,"width":822,"sha":"143bc3b3f92c8f8d38fe33548898fec8","url":"https://img.federalregister.gov/ER08NO19.019/ER08NO19.019_large.png","height":978},"original_size":{"identifier":"ER08NO19.019","content_type":"image/png","size":184341,"width":4430,"sha":"8cee9357ad2ea5d52e7025d11ca02bb2","url":"https://img.federalregister.gov/ER08NO19.019/ER08NO19.019_original_size.png","height":5268}},"ER08NO19.017":{"large":{"identifier":"ER08NO19.017","content_type":"image/png","size":79643,"width":823,"sha":"bab2b3be78c8962728b16fdb85c71ba5","url":"https://img.federalregister.gov/ER08NO19.017/ER08NO19.017_large.png","height":1251},"original_size":{"identifier":"ER08NO19.017","content_type":"image/png","size":163274,"width":3850,"sha":"6f8d3aef447353aac634dce3c3f68ea0","url":"https://img.federalregister.gov/ER08NO19.017/ER08NO19.017_original_size.png","height":5853}},"ER08NO19.018":{"large":{"identifier":"ER08NO19.018","content_type":"image/png","size":84051,"width":544,"sha":"e4753eb345f243471c4ed8b3e3e66f18","url":"https://img.federalregister.gov/ER08NO19.018/ER08NO19.018_large.png","height":1646},"original_size":{"identifier":"ER08NO19.018","content_type":"image/png","size":96415,"width":1934,"sha":"43d6d8f8b7ffeeefee0df320b72f23bc","url":"https://img.federalregister.gov/ER08NO19.018/ER08NO19.018_original_size.png","height":5853}},"ER08NO19.015":{"large":{"identifier":"ER08NO19.015","content_type":"image/png","size":86991,"width":822,"sha":"498e8245ded60be9daceba498eb603de","url":"https://img.federalregister.gov/ER08NO19.015/ER08NO19.015_large.png","height":1248},"original_size":{"identifier":"ER08NO19.015","content_type":"image/png","size":171798,"width":3855,"sha":"90ac54a9910096473b67220136335d55","url":"https://img.federalregister.gov/ER08NO19.015/ER08NO19.015_original_size.png","height":5853}},"ER08NO19.016":{"large":{"identifier":"ER08NO19.016","content_type":"image/png","size":97094,"width":822,"sha":"7c868fa3d0d2e36b7dd9f4f90cf8948b","url":"https://img.federalregister.gov/ER08NO19.016/ER08NO19.016_large.png","height":1248},"original_size":{"identifier":"ER08NO19.016","content_type":"image/png","size":162931,"width":3855,"sha":"dee90de35d4ddb8f92019369d6b562fe","url":"https://img.federalregister.gov/ER08NO19.016/ER08NO19.016_original_size.png","height":5853}},"ER08NO19.013":{"large":{"identifier":"ER08NO19.013","content_type":"image/png","size":108308,"width":823,"sha":"29446c771cb427aec7682d3c842d7f4f","url":"https://img.federalregister.gov/ER08NO19.013/ER08NO19.013_large.png","height":1248},"original_size":{"identifier":"ER08NO19.013","content_type":"image/png","size":205669,"width":3859,"sha":"04eba463533250059944091e5cd145da","url":"https://img.federalregister.gov/ER08NO19.013/ER08NO19.013_original_size.png","height":5853}},"ER08NO19.057":{"large":{"identifier":"ER08NO19.057","content_type":"image/png","size":12880,"width":823,"sha":"083c3d95d4ddb20421d86ce6a707c2ad","url":"https://img.federalregister.gov/ER08NO19.057/ER08NO19.057_large.png","height":125},"original_size":{"identifier":"ER08NO19.057","content_type":"image/png","size":23773,"width":3900,"sha":"91cfaddd97e45e99d9f2ae18ff5df401","url":"https://img.federalregister.gov/ER08NO19.057/ER08NO19.057_original_size.png","height":591}},"ER08NO19.014":{"large":{"identifier":"ER08NO19.014","content_type":"image/png","size":99878,"width":823,"sha":"03891ef8a6dbbfb1f4c80038b5489aa7","url":"https://img.federalregister.gov/ER08NO19.014/ER08NO19.014_large.png","height":1247},"original_size":{"identifier":"ER08NO19.014","content_type":"image/png","size":184418,"width":3862,"sha":"d8366ec4e8991763d7756f4959746266","url":"https://img.federalregister.gov/ER08NO19.014/ER08NO19.014_original_size.png","height":5853}},"ER08NO19.058":{"large":{"identifier":"ER08NO19.058","content_type":"image/png","size":15382,"width":823,"sha":"4e3f6029c8b1490558a2c50afb79e707","url":"https://img.federalregister.gov/ER08NO19.058/ER08NO19.058_large.png","height":162},"original_size":{"identifier":"ER08NO19.058","content_type":"image/png","size":28860,"width":4053,"sha":"dbecc9d359796b9de025e70996f3656a","url":"https://img.federalregister.gov/ER08NO19.058/ER08NO19.058_original_size.png","height":797}},"ER08NO19.011":{"large":{"identifier":"ER08NO19.011","content_type":"image/png","size":158269,"width":666,"sha":"c04a8dfe97297974036260f8026e1618","url":"https://img.federalregister.gov/ER08NO19.011/ER08NO19.011_large.png","height":1499},"original_size":{"identifier":"ER08NO19.011","content_type":"image/png","size":149440,"width":2370,"sha":"22b4787ae0266560ef68ca7f39439a54","url":"https://img.federalregister.gov/ER08NO19.011/ER08NO19.011_original_size.png","height":5333}},"ER08NO19.055":{"large":{"identifier":"ER08NO19.055","content_type":"image/png","size":78976,"width":823,"sha":"ea625b0e39838da001f624844249683a","url":"https://img.federalregister.gov/ER08NO19.055/ER08NO19.055_large.png","height":843},"original_size":{"identifier":"ER08NO19.055","content_type":"image/png","size":285568,"width":4111,"sha":"caee6c3de2850f91ecd9534e8fc91aa6","url":"https://img.federalregister.gov/ER08NO19.055/ER08NO19.055_original_size.png","height":4210}},"ER08NO19.012":{"large":{"identifier":"ER08NO19.012","content_type":"image/png","size":112905,"width":823,"sha":"5a6d5e4f714782667ac1d78a6250fba5","url":"https://img.federalregister.gov/ER08NO19.012/ER08NO19.012_large.png","height":1259},"original_size":{"identifier":"ER08NO19.012","content_type":"image/png","size":196191,"width":3824,"sha":"79be35ad8da4bf5ece519894fc39e550","url":"https://img.federalregister.gov/ER08NO19.012/ER08NO19.012_original_size.png","height":5853}},"ER08NO19.056":{"large":{"identifier":"ER08NO19.056","content_type":"image/png","size":14909,"width":823,"sha":"b6a77ec1fac09bad854d7de703ec163e","url":"https://img.federalregister.gov/ER08NO19.056/ER08NO19.056_large.png","height":166},"original_size":{"identifier":"ER08NO19.056","content_type":"image/png","size":22887,"width":3379,"sha":"719c8b26823a403acec02fd71bc610d4","url":"https://img.federalregister.gov/ER08NO19.056/ER08NO19.056_original_size.png","height":682}},"ER08NO19.031":{"large":{"identifier":"ER08NO19.031","content_type":"image/png","size":94864,"width":823,"sha":"013d7ebc78d6780a2ce92c999c282006","url":"https://img.federalregister.gov/ER08NO19.031/ER08NO19.031_large.png","height":1059},"original_size":{"identifier":"ER08NO19.031","content_type":"image/png","size":177356,"width":4149,"sha":"301bedb34f701e60949a97967142f70a","url":"https://img.federalregister.gov/ER08NO19.031/ER08NO19.031_original_size.png","height":5339}},"ER08NO19.032":{"large":{"identifier":"ER08NO19.032","content_type":"image/png","size":91689,"width":823,"sha":"a72cb6209915cb69c64e3974ffb72fe4","url":"https://img.federalregister.gov/ER08NO19.032/ER08NO19.032_large.png","height":1058},"original_size":{"identifier":"ER08NO19.032","content_type":"image/png","size":165613,"width":4149,"sha":"1271c0ad1b8bd0dbfae28da7ff5ee606","url":"https://img.federalregister.gov/ER08NO19.032/ER08NO19.032_original_size.png","height":5336}},"ER08NO19.030":{"large":{"identifier":"ER08NO19.030","content_type":"image/png","size":108258,"width":823,"sha":"c1e05fa16fdaf53c47cd815b96f1ecc1","url":"https://img.federalregister.gov/ER08NO19.030/ER08NO19.030_large.png","height":1070},"original_size":{"identifier":"ER08NO19.030","content_type":"image/png","size":205008,"width":4149,"sha":"fe86392a0bc6d60ff0837d995219024c","url":"https://img.federalregister.gov/ER08NO19.030/ER08NO19.030_original_size.png","height":5396}},"ER08NO19.028":{"large":{"identifier":"ER08NO19.028","content_type":"image/png","size":105590,"width":822,"sha":"25e26c26963dc4d55eb2758e7b159a78","url":"https://img.federalregister.gov/ER08NO19.028/ER08NO19.028_large.png","height":1051},"original_size":{"identifier":"ER08NO19.028","content_type":"image/png","size":192753,"width":4149,"sha":"09fd51177b63a039db9c05b560406968","url":"https://img.federalregister.gov/ER08NO19.028/ER08NO19.028_original_size.png","height":5302}},"ER08NO19.029":{"large":{"identifier":"ER08NO19.029","content_type":"image/png","size":104323,"width":822,"sha":"fa939c62865c8fd8817548df1f9bad08","url":"https://img.federalregister.gov/ER08NO19.029/ER08NO19.029_large.png","height":1051},"original_size":{"identifier":"ER08NO19.029","content_type":"image/png","size":188187,"width":4149,"sha":"65af72ad96354c5e4b690f9c7cba9977","url":"https://img.federalregister.gov/ER08NO19.029/ER08NO19.029_original_size.png","height":5302}},"ER08NO19.026":{"large":{"identifier":"ER08NO19.026","content_type":"image/png","size":109377,"width":822,"sha":"56aa7540c8dc03cb3e294ec06628479e","url":"https://img.federalregister.gov/ER08NO19.026/ER08NO19.026_large.png","height":1051},"original_size":{"identifier":"ER08NO19.026","content_type":"image/png","size":188716,"width":4149,"sha":"34e08c5fcc36341fd7f916d3c5b7ed1d","url":"https://img.federalregister.gov/ER08NO19.026/ER08NO19.026_original_size.png","height":5302}},"ER08NO19.103":{"large":{"identifier":"ER08NO19.103","content_type":"image/png","size":14812,"width":817,"sha":"b6a63078eb2553c4a1685cd7f7c67972","url":"https://img.federalregister.gov/ER08NO19.103/ER08NO19.103_large.png","height":177},"original_size":{"identifier":"ER08NO19.103","content_type":"image/png","size":20967,"width":3171,"sha":"479fea9d2a78130348682393164b25b8","url":"https://img.federalregister.gov/ER08NO19.103/ER08NO19.103_original_size.png","height":687}},"ER08NO19.027":{"large":{"identifier":"ER08NO19.027","content_type":"image/png","size":103556,"width":822,"sha":"9f0b6caf6cf14b865dd815d0439ca722","url":"https://img.federalregister.gov/ER08NO19.027/ER08NO19.027_large.png","height":1051},"original_size":{"identifier":"ER08NO19.027","content_type":"image/png","size":182461,"width":4149,"sha":"3cf19436c591e2d3f593708106ae76b3","url":"https://img.federalregister.gov/ER08NO19.027/ER08NO19.027_original_size.png","height":5302}},"ER08NO19.024":{"large":{"identifier":"ER08NO19.024","content_type":"image/png","size":101763,"width":822,"sha":"487da9465f2c1f95f23ee1cd25753822","url":"https://img.federalregister.gov/ER08NO19.024/ER08NO19.024_large.png","height":1051},"original_size":{"identifier":"ER08NO19.024","content_type":"image/png","size":172867,"width":4149,"sha":"de35a92122a7545df3290ab21b45209b","url":"https://img.federalregister.gov/ER08NO19.024/ER08NO19.024_original_size.png","height":5302}},"ER08NO19.025":{"large":{"identifier":"ER08NO19.025","content_type":"image/png","size":103447,"width":822,"sha":"aa80195438204fe43d8f74fe9acacfc9","url":"https://img.federalregister.gov/ER08NO19.025/ER08NO19.025_large.png","height":1051},"original_size":{"identifier":"ER08NO19.025","content_type":"image/png","size":179696,"width":4149,"sha":"a0f826044c534d7c556c51ae5133a304","url":"https://img.federalregister.gov/ER08NO19.025/ER08NO19.025_original_size.png","height":5302}},"ER08NO19.022":{"large":{"identifier":"ER08NO19.022","content_type":"image/png","size":28073,"width":823,"sha":"784afbc2f4ae7511691de01bbf659afb","url":"https://img.federalregister.gov/ER08NO19.022/ER08NO19.022_large.png","height":303},"original_size":{"identifier":"ER08NO19.022","content_type":"image/png","size":45243,"width":3846,"sha":"584a47ff28350c80d149e1be10d260fa","url":"https://img.federalregister.gov/ER08NO19.022/ER08NO19.022_original_size.png","height":1416}},"ER08NO19.023":{"large":{"identifier":"ER08NO19.023","content_type":"image/png","size":70347,"width":823,"sha":"9c289b982cc8f1ce19326ae512e35dae","url":"https://img.federalregister.gov/ER08NO19.023/ER08NO19.023_large.png","height":646},"original_size":{"identifier":"ER08NO19.023","content_type":"image/png","size":107505,"width":4149,"sha":"2083dbb816599e2161f789c56b0c8d55","url":"https://img.federalregister.gov/ER08NO19.023/ER08NO19.023_original_size.png","height":3258}}},"json_url":"https://www.federalregister.gov/api/v1/documents/2019-24026?publication_date=2019-11-08","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2019-11-08/2019-24026/mods.xml","not_received_for_publication":null,"page_length":169,"page_views":{"count":24571,"last_updated":"2026-04-04 18:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2019-11-08/pdf/2019-24026.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2019-24026.pdf?1572552925","publication_date":"2019-11-08","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2019/11/08/2019-24026.txt","regulation_id_number_info":{"0938-AT68":{"issue":"201910","html_url":"https://www.federalregister.gov/regulations/0938-AT68/cy-2020-home-health-prospective-payment-system-rate-update-and-quality-reporting-requirements-cms-17","title":"CY 2020 Home Health Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1711-F)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201910&RIN=0938-AT68&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AT68"],"regulations_dot_gov_info":{"supporting_documents":[],"regulatory_plan":{"html_url":"https://www.federalregister.gov/regulations/0938-AT68/cy-2020-home-health-prospective-payment-system-rate-update-and-quality-reporting-requirements-cms-17","title":"CY 2020 Home Health Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1711-F)"},"comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2019-0100","supporting_documents_count":0,"docket_id":"CMS-2019-0100","regulation_id_number":"0938-AT68","title":"CY 2020 Home Health Prospective Payment System Rate Update; Value-Based Purchasing Model; Quality Reporting Requirements CMS-1711-P","checked_regulationsdotgov_at":"2020-01-01T04:30:08Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":60478,"subtype":null,"title":"Medicare and Medicaid Programs; CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements","toc_doc":"CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; etc.","toc_subject":"Medicare and Medicaid Programs:\n","topics":["Administrative practice and procedure","Grant programs-health","Health facilities","Health professions","Kidney diseases","Medicare","Reporting and recordkeeping requirements","X-rays"],"type":"Rule","volume":84}