Finding Medicare Fee-For-Service (FFS)
June 8, 2022
Payment System Rules: Schedules and
Michele L. Malloy
Resources
Research Librarian

The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care
facilities based on statutorily established payment systems, most of which are updated annually

through regulations. These proposed and final rules follow schedules based on requirements
found in statute, regulation, or both.
As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health care facilities
and providers. Congressional Members and committees may comment, and are often contacted by provider and beneficiary
groups. Tracking the status and requirements for specific rules can be onerous, since they have different schedules and web
locations.
This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the
payment systems, their main portals on the Centers for Medicare & Medicaid Services (CMS) website, the typical
rulemaking schedule, statutory and regulatory requirements, and the most recently issued proposed rules, public comments,
final rules, and subsequent corrections. The table also includes embedded links to the applicable resources. Not all payment
systems include detailed statutory and regulatory requirements, as noted in the table.
Congressional Research Service

link to page 5 Finding Medicare Fee-For-Service (FFS) Payment System Rules

Introduction
The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care
facilities based on statutorily established payment systems, most of which are updated annually
through regulations. These proposed and final rules follow schedules based on requirements
found in statute, regulation, or both. Medicare payment systems that follow annual regulatory
updates with comment periods include the following:
 Medicare Physician Fee Schedule Payment (MPFS or PFS),
 Hospital Outpatient Prospective Payment System (OPPS),
 Ambulatory Surgical Center Payment System (ASC Payment System),
 Acute Inpatient Prospective Payment System (IPPS),
 Long-Term Care Hospital Prospective Payment System (LTCH PPS),
 Skilled Nursing Facility Prospective Payment System (SNF PPS),
 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS),
 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS),
 Home Health Prospective Payment System (Home Health PPS),
 End Stage Renal Disease Prospective Payment System (ESRD PPS), and
 Hospice Wage Index and Payment Rate.
As Medicare FFS payment system proposed and final rules are issued, they impact payments
received by health care facilities and providers. Congressional Members and committees may
comment, and are often contacted by provider and beneficiary groups. Tracking the status and
requirements for specific rules can be onerous, because they have different schedules and web
locations. This report contains information on these payment system rules in a quick reference
table.
To learn more about these payment systems, please see applicable sections of CRS Report
R40425, Medicare Primer. In addition, the Medicare Payment Advisory Commission (MedPAC)
produces Payment Basics,1 a series of brief overviews of how Medicare’s payment systems
function.
Medicare Fee-For-Service Payment System Rules:
Schedules and Resources
Medicare FFS payment system rules and the associated statutory and regulatory requirements
regarding timeline and public comment can be difficult to locate. Table 1 compiles the payment
systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the
typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued
proposed and final rules, including agency docket numbers, Federal Register citations, public
comments available on Regulations.gov, and any corrections issued. The table also includes
embedded links to the applicable resources and notes when rulemaking timelines and comment
periods are not specified. Not all payment systems include detailed statutory and regulatory
requirements, as noted in the table.

1 MedPAC, Payment Basics, at http://medpac.gov/-documents-/payment-basics.
Congressional Research Service

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Table 1. Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Payment Policies Under the July-August November
42 USC §1395w-4: Payment for
N/A
2022 Final Rule
Physician Fee Schedule
physicians’ services
(11/19/2021) CMS-1751-F

(b)(1) “Before November 1 of
86 FR 64996
Medicare Physician Fee
the preceding year, for each year

Schedule Payment (PFS)
beginning with 1998, subject to
subsection (p), the Secretary
2022 Proposed Rule
shall establish, by regulation, fee
(7/23/2021) CMS-1751-P
schedules that establish payment
86 FR 39104
amounts for all physicians'
services furnished in all fee
Comments: Regulations.gov
schedule areas (as defined in
CMS-2021-0119
subsection (j)(2)) for the year."

2021 Final Rule
Note: Public comment is not
(12/28/2020) CMS-1734-F
addressed broadly for PFS in
85 FR 84472
statute. However, public
comment is addressed for
Corrections: 86 FR 5020
aspects of the physician payment
(1/19/2021) and 86 FR 14690
system, such as the development
(3/18/2021)
of categories and codes.

2021 Proposed Rule
(8/17/2020) CMS-1734-P
85 FR 50074
Comments: Regulations.gov
CMS-2020-0088

2020 Final Rule
(11/15/2019) CMS-1715-F
84 FR 62568

CRS-2

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2020 Proposed Rule
(8/14/2019) CMS-1715-P
84 FR 40482
Comments: Regulations.gov
CMS-2019-0111
Hospital Outpatient
July-August November
42 USC §1395l: Payment of
42 CFR §419.50 Annual review.
2022 Final Rule
Prospective Payment and
-December benefits

(11/16/2021) CMS-1753-FC
Ambulatory Surgical
(t) Prospective payment system
Center Payment Systems
42 CFR §416.130 Publication of revised
86 FR 63458
for hospital outpatient
payment methodologies.

department services

"Whenever CMS proposes to revise the
Hospital Outpatient

2022 Proposed Rule
payment rate for ASCs, CMS publishes a notice
Prospective Payment
Note: Specific timelines for
in the Federal Register describing the revision.
(8/4/2021) CMS-1753-P
System (OPPS)
rulemaking and comments are
The notice also explains the basis on which the
86 FR 42018

not addressed in statute.
rates were established. After reviewing public
Comments: Regulations.gov
Ambulatory Surgical

comments, CMS publishes a notice establishing
CMS-2021-0124
Center (ASC) Payment
the rates authorized by this section. In setting
42 USC §1395l: Payment of

System
these rates, CMS may adopt reasonable
benefits
classifications of facilities and may establish
2021 Final Rule
(i) Outpatient surgery
different rates for different types of surgical
(12/29/2020) CMS-1736-FC
“Taking into account the
procedures."
85 FR 85866
recommendations in the report
Corrections: 86 FR 11428
under section 626(d) of
(2/25/2021)
Medicare Prescription Drug,
Improvement, and Modernization

Act of 2003, the Secretary shall
2021 Proposed Rule
implement a revised payment
(8/12/2020) CMS-1736-P
system for payment of surgical
services furnished in ambulatory
85 FR 48772
surgical centers."
Comments: Regulations.gov

CMS-2020-0090
Note: Specific timelines for

rulemaking and comments
2020 Final Rule
CRS-3

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
beyond the initial year are not
(11/27/2019) CMS-1717-F2
addressed in statute.
84 FR 65524

2020 Proposed Rule
(8/9/2019) CMS-1717-P
84 FR 39398
Comments: Regulations.gov
CMS-2019-0109
Hospital Inpatient
April-May
August-
42 USC §1395ww: Payments to
42 CFR §412.8 Publication of schedules for
2023 Proposed Rule
Prospective Payment
October
hospitals for inpatient hospital
determining prospective payment rates.
(5/10/2022) CMS-1771-P
Systems for Acute Care
services
"(b) Annual publication of schedule for
Hospitals and the Long-
87 FR 28108
(e)(1)(C)(5)
determining prospective payment rates. (1)
Term Care Hospital
CMS proposes changes in the methods,
Comments: Regulations.gov
Prospective Payment
“The Secretary shall cause to
amounts, and factors used to determine
CMS-2022-0074
System
have published in the Federal
Register, not later than- (A) the
inpatient prospective payment rates in a

April 1 before each fiscal year
Federal Register document published for public
2022 Final Rule
Acute Inpatient
(beginning with fiscal year 1986),
comment not later than the April 1 before the
(8/13/2021) CMS-1752-F
Prospective Payment
the Secretary’s proposed
beginning of the Federal fiscal year in which the
86 FR 44774
System (IPPS)
recommendations under
proposed changes would apply.

paragraph (4) for that fiscal year
(2) Except as provided in paragraph (c) of this
for public comment, and (B) the
section, CMS publishes a Federal Register
2022 Proposed Rule
Long-Term Care Hospital
August 1 before such fiscal year
document setting forth final methods, amounts,
Prospective Payment
(5/10/2021) CMS-1752-P
after such consideration of public and factors for determining inpatient
System (LTCH PPS)
comment on the proposal as is
prospective payment rates not later than the
86 FR 25070
feasible in the time available, the
August 1 before the Federal fiscal year in which
Corrections: 86 FR 33157
Secretary's final
the rates would apply."
(6/24/2021)
recommendations under such

Comments: Regulations.gov
paragraph for that year."
42 CFR §412.535 Publication of the Federal
CMS-2021-0070

prospective payment rates.

42 USC §1395ww: Payments to
"Except as specified in paragraph (b), CMS
2021 Final Rule
hospitals for inpatient hospital
publishes information pertaining to the long-
(9/18/2020) CMS-1735-F
services
term care hospital prospective payment system
CRS-4

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
(m) Prospective payment for
effective for each annual update in the Federal
85 FR 58432
long-term care hospitals
Register.
Corrections: 85 FR 78748

(c) For the period beginning on or after
(12/7/2020)
Note: Specific timelines for
October 1, 2009, information on the

rulemaking and comments for
unadjusted Federal payment rates and a
2021 Proposed Rule
Long-Term Care Hospital PPS
description of the methodology and data used
are not addressed in statute.
to calculate the payment rates are published on
(5/29/2020) CMS-1735-P
or before August 1 prior to the start of the
85 FR 32460
Federal fiscal year which begins October 1,
Comments: Regulations.gov
unless for good cause it is published after
CMS-2020-0052
August 1, but before September 1.

(d) Information on the LTC-DRG classification
and associated weighting factors is published on 2020 Final Rule
or before August 1 prior to the beginning of
(8/16/2019) CMS-1716-F
each Federal fiscal year."
84 FR 42044

2020 Proposed Rule
(5/3/2019) CMS-1716-P
84 FR 19158
Corrections: 84 FR 28263
(6/18/2019)
Comments: Regulations.gov
CMS-2019-0073
Prospective Payment
April-May
August
42 USC §1395yy: Payment to
42 CFR §413.345 Publication of Federal
2023 Proposed Rule
System and Consolidated
skilled nursing facilities for
prospective payment rates.
(4/15/2022) CMS-1765-P
Billing for Skilled Nursing
routine service costs
"CMS publishes information pertaining to each
Facilities (SNF)
87 FR 22720
(e)(4)(H)
update of the Federal payment rates in the

Comments: Regulations.gov
“The Secretary shall provide for
Federal Register. This information includes the
Skilled Nursing Facility
publication in the Federal
standardized Federal rates, the resident
CMS-2022-0069
Prospective Payment
Register, before May 1, 1998
classification system that provides the basis for

System (SNF PPS)
(with respect to fiscal period
case-mix adjustment, and the factors to be
2022 Final Rule
described in subparagraph (E)(i))
applied in making the area wage adjustment.
CRS-5

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
and before the August 1
This information is published before May 1 for
(8/4/2021) CMS-1746-F
preceding each succeeding fiscal
the fiscal year 1998 and before August 1 for the 86 FR 42424
year (with respect to that
fiscal years 1999 and after."
succeeding fiscal year), of-

(i) the unadjusted Federal per
2022 Proposed Rule
diem rates to be applied to days
(4/15/2021) CMS- 1746-P
of covered skilled nursing facility
86 FR 19954
services furnished during the
Comments: Regulations.gov
fiscal year,
CMS-2021-0062
(ii) the case mix classification

system to be applied under
subparagraph (G)(i) with respect
2021 Final Rule
to such services during the fiscal
(8/5/2020) CMS-1737-F
year, and
85 FR 47594
(iii) the factors to be applied in

making the area wage adjustment
under subparagraph (G)(ii) with
2021 Proposed Rule
respect to such services."
(4/15/2020) CMS-1737-P

85 FR 20914
Note: The timeline for the
Comments: Regulations.gov
proposed rule and comments are
CMS-2020-0036
not addressed in statute.

2020 Final Rule
(8/7/2019) CMS-1718-F
84 FR 38728

2020 Proposed Rule
(4/25/2019) CMS-1718-P
84 FR 17620
Comments: Regulations.gov
CMS-2019-0070
CRS-6

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Inpatient Rehabilitation
April-May
August
42 USC §1395ww: Payments to
42 CFR §412.628 Publication of the Federal
2023 Proposed Rule
Facility Prospective
hospitals for inpatient hospital
prospective payment rates.
(4/6/2022) CMS-1767-P
Payment System
services
"We publish information pertaining to the
87 FR 20218

(j)(5)
inpatient rehabilitation facility prospective
Comments: Regulations.gov
Inpatient Rehabilitation
“The Secretary shall provide for
payment system effective for each fiscal year in
Facility Prospective
publication in the Federal
the Federal Register. This information includes
CMS-2022-0061
Payment System (IRF PPS)
Register, on or before August 1
the unadjusted Federal payment rates, the

before each fiscal year (beginning
patient classification system and associated
2022 Final Rule
with fiscal year 2001), of the
weighting factors, and a description of the
(8/4/2021) CMS-1748-F
classification and weighting
methodology and data used to calculate the
factors for case mix groups
payment rates. This information is published on
86 FR 42362
under paragraph (2) for such
or before August 1 prior to the beginning of

fiscal year and a description of
each fiscal year."
2022 Proposed Rule
the methodology and data used
in computing the prospective
(4/12/2021) CMS-1748-P
payment rates under this
86 FR 19086
subsection for that fiscal year."
Comments: Regulations.gov

CMS-2021-0057
Note: Only the final rule

deadline is specified, the
2021 Final Rule
proposed rule is not addressed
in statute. Public comment is not
(8/10/2020) CMS-1729-F
addressed in statute.
85 FR 48424

2021 Proposed Rule
(4/21/2020) CMS-1729-P
85 FR 22065
Comments: Regulations.gov
CMS-2020-0039

2020 Final Rule
(8/8/2019) CMS-1710-F
CRS-7

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
84 FR 39054

2020 Proposed Rule
(4/24/2019) CMS-1710-P
84 FR 17244
Corrections: 84 FR 24734
(5/29/2019)
Comments: Regulations.gov
CMS-2019-0066
Inpatient Psychiatric
April-May
August
42 USC §1395ww: Payments to
42 CFR §412.428 Publication of changes to the
2023 Proposed Rule
Facilities Prospective
hospitals for inpatient hospital
inpatient psychiatric facility prospective
(4/4/2022) CMS-1769-P
Payment System
services
payment system.
87 FR 19415

(s) Prospective payment for
“CMS will issue annually in the Federal Register
Comments: Regulations.gov
Inpatient Psychiatric Facility
psychiatric hospitals
information pertaining to changes to the
Prospective Payment

inpatient psychiatric facility prospective
CMS-2022-0062
System (IPF PPS)
payment system."
Note: specific timelines for

rulemaking and comments for
2022 Final Rule
Inpatient Psychiatric Facility PPS
(8/4/2021) CMS-1750-F
are not addressed in statute.
86 FR 42608
Deadlines for quality measures
are specified.

2022 Proposed Rule
(4/13/2021) CMS-1750-P
86 FR 19480
Comments: Regulations.gov
CMS-2021-0060

2021 Final Rule
(8/4/2020) CMS-1731-F
85 FR 47042
CRS-8

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Corrections: 85 FR 52923
(8/27/2020)

2021 Proposed Rule
(4/14/2020) CMS-1731-P
85 FR 20625
Comments: Regulations.gov
CMS-2020-0035

2020 Final Rule
(8/6/2019) CMS-1712-F
84 FR 38424

2020 Proposed Rule
(4/23/2019) CMS-1712-P
84 FR 16948
Comments: Regulations.gov
CMS-2019-0067
Home Health Prospective
July
November
42 USC §1395fff: Prospective
42 CFR §484.225 Annual update of the
2022 Final Rule
Payment System
payment for home health
unadjusted national, standardized prospective
(11/9/2021) CMS-1747-F

services
payment rates.
86 FR 62240
Home Health Prospective

“CMS annually updates the unadjusted national,

Payment System (Home
Note: Specific timelines for
standardized prospective payment rate on a
Health PPS)
rulemaking and comments for
calendar year basis (in accordance with section
2022 Proposed Rule
Home Health PPS are not
1895(b)(1)(B) of the Act)."b
(7/7/2021) CMS-1747-P
addressed in statute.
86 FR 35874
Comments: Regulations.gov
CMS-2021-0112

CRS-9

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2021 Final Rule
(11/4/2020) CMS-1730-F
85 FR 70298

2021 Proposed Rule
(6/30/2020) CMS-1730-P
85 FR 39408
Corrections: 85 FR 43805
(7/20/2020)
Comments: Regulations.gov
CMS-2020-0077

2020 Final Rule
(11/8/2019) CMS-1711-FC
84 FR 60478

2020 Proposed Rule
(7/18/2019) CMS-1711-P
84 FR 34598
Comments: Regulations.gov
CMS-2019-0100
End-Stage Renal Disease
July
November
42 USC §1395rr: End stage renal
42 CFR §413.196 Notification of changes in
2022 Final Rule
Prospective Payment
disease program
rate-setting methodologies and payment rates.
(11/8/2021) CMS-1749-F
System

“(b) Changes in payment rates resulting from
86 FR 61874

Note: Specific timelines for
incorporation of updated cost data or general
Corrections: 86 FR 70982
End Stage Renal Disease
rulemaking and comments for
revisions of geographic labor cost adjustment
(12/14/2021)
Prospective Payment
ESRD PPS are not addressed in
factors are announced by notice published in
System (ESRD PPS)
statute.
the Federal Register without opportunity for

prior comment. Revisions of the rate-setting
2022 Proposed Rule
methodology are published in the Federal
CRS-10

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Register in accordance with the Department’s
(7/9/2021) CMS-1749-P
established rulemaking procedures."
86 FR 36322
Comments: Regulations.gov
CMS-2021-0114

2021 Final Rule
(11/9/2020) CMS-1732-F
85 FR 71398

2021 Proposed Rule
(7/13/2020) CMS-1732-P
85 FR 42132
Comments: Regulations.gov
CMS-2020-0079

2020 Final Rule
(11/8/2019) CMS-1713-F
84 FR 60648

2020 Proposed Rule
(8/6/2019) CMS-1713-P
84 FR 38330
Comments: Regulations.gov
CMS-2019-0110
Hospice Wage Index and
April-May
August
42 USC §1395f: Conditions of
42 CFR §418.306 Annual update of the
2023 Proposed Rule
Payment Rate
and limitations on payment for
payment rates and adjustment for area wage
(4/4/2022) CMS-1773-P

services
differences.
87 FR 19442
Hospice Wage Index and
(i) Payment for hospice care
“(b) Annual update of the payment rates. The
Comments: Regulations.gov
Payment Rate

payment rates for routine home care and other
CRS-11

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Note: Specific timelines for
services included in hospice care are the
CMS-2022-0060
rulemaking and comments for
payment rates in effect under this paragraph

hospice payment rates are not
during the previous fiscal year increased by the
addressed in statute.
hospice payment update percentage increase
2022 Final Rule
(as defined in sections1814(i)(1)(C) of the Act),
(8/4/2021) CMS-1754-F
applicable to discharges occurring in the fiscal
86 FR 42528
year."b

2022 Proposed Rule
(4/14/2021) CMS-1754-P
86 FR 19700
Comments: Regulations.gov
CMS-2021-0061

2021 Final Rule
(8/4/2020) CMS-1733-F
85 FR 47070

2021 Proposed Rule
(4/15/2020) CMS-1733-P
85 FR 20949
Comments: Regulations.gov
CMS-2020-0037

2020 Final Rule
(8/6/2019) CMS-1714-F
84 FR 38484

2020 Proposed Rule
(4/25/2019) CMS-1714-P
CRS-12

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Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
84 FR 17570
Comments: Regulations.gov
CMS-2019-0068
Source: Compiled by the Congressional Research Service (CRS).
Notes: Table compiled using Centers for Medicare & Medicaid Services (CMS) websites, Federal Register, and Regulations.gov. In some cases, although multiple payment
systems are covered by one rule, they are combined here in one row but listed separately. Typical months when proposed and final rules are issued can vary, and the
months we list are based on CRS analysis of Federal Register publication dates from the past 10 years. Additionally, corrections are sometimes issued after the final rule.
a. Some Medicare FFS payment systems are not updated through notice and comment or on an annual basis, but only periodically. These include Clinical Laboratory
Fee Schedule, Shared Savings Program, and Ambulance Fee Schedule. Please see the embedded CMS links for more information, including the most recent rules.
b. At times, regulations reference the Social Security Act rather than the U.S. Code citation. The Social Security Administration provides a cross-reference table at
https://www.ssa.gov/OP_Home/comp2/G-APP-H.html.

CRS-13

Finding Medicare Fee-For-Service (FFS) Payment System Rules

Author Information

Michele L. Malloy

Research Librarian

Acknowledgments
CRS Analysts Jim Hahn, Marco Villagrana, and Phoenix Voorhies aided in the compilation and review of
the statutory and regulatory requirements of selected payment system rules.

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
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Congressional Research Service
R46797 · VERSION 7 · UPDATED
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