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Medical Loss Ratio CMS

Details: The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires medicaid medical loss ratio

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio Go Now

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Medical Loss Ratio Search Tool CMS

Details: Medical Loss Ratio Search Tool About the Search tool. Use the search tool to find commercial Medical Loss Ratio reports for health insurance companies offering coverage in the individual, small group, or large group market. To get started, select a reporting year and click the Search button. medical loss ratio formula

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› Url: https://www.cms.gov/cciio/mlr Go Now

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Medical Loss Ratio CMS

Details: Starting with contract year 2014, Medicare Advantage (MA) organizations, Part D prescription drug plan sponsors, and cost plans are required to submit a medical loss ratio (MLR) report to CMS on an annual basis. The purpose of this page is to share information relating to the MLR reporting process. Overview medicaid medical loss ratio explained

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› Url: https://www.cms.gov/Medicare/Medicare-Advantage/Plan-Payment/MedicalLossRatio Go Now

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Medical Loss Ratio: Getting Your Money's Worth on - CMS

Details: Although the law allows HHS to develop separate monetary penalties for medical loss ratio non-compliance, HHS has adopted the HIPAA penalties in this regulation. The regulation’s penalty for each violation is $100 per entity, per day, per individual affected by … aca medical loss ratio requirements

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› Url: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/medical-loss-ratio Go Now

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Medical Loss Ratio: Getting Your Money's Worth on - CMS

Details: In December 2010, the Department of Health and Human Services (HHS) issued a regulation implementing this provision of the Affordable Care Act, known as the medical loss ratio (MLR). The MLR will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money. medical loss ratio for drug manufacturer

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› Url: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/mlrfinalrule Go Now

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Medical Loss Ratio CMS

Details: Michigan Request for an Adjustment of the Medical Loss Ratio StandardThe Affordable Care Act allows the Secretary to adjust the Medical Loss Ratio (MLR) standard for a state if it is determined that meeting the 80 percent Medical Loss Ratio standard may destabilize the individual market. In order to qualify for this adjustment, a state must demonstrate that requiring insurers in its … medical loss ratio requirements

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/mlr_adj_michigan Go Now

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Medical Loss Ratio Medicaid

Details: In alignment with medical loss ratio (MLR) requirements for health plans operating in the private market and Medicare Advantage, the Medicaid and CHIP managed care rule provides a credibility adjustment to account for the potential variation in smaller managed care plans. As defined in 42 CFR 438.8 (b), the credibility adjustment is used to medical loss ratio refund

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› Url: https://www.medicaid.gov/medicaid/managed-care/guidance/medical-loss-ratio/index.html Go Now

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Department of Health and Human Services - edit.cms.gov

Details: Centers for Medicare & Medicaid Services Center for Program Integrity . California Medicaid Managed Care Plans’ Medical Loss Ratio Calculations . Review Periods: January 1, 2014 to June 30, 2015, and July 1, 2015 to June 30, 2016 . Medical Loss Ratio Examination . Final Report . June 2020

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› Url: https://edit.cms.gov/files/document/california-medical-loss-ratio-examination-report.pdf Go Now

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CMS suspends Part D enrollment in 2022 for UnitedHealth

Details: The Part D plans were dinged by CMS for not maintaining a medical loss ratio of 85%, meaning 85% of every premium dollar must go toward healthcare coverage and the …

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› Url: https://www.fiercehealthcare.com/payer/cms-suspends-part-d-enrollment-2022-for-unitedhealth-anthem-plans-for-failing-to-meet-mlr Go Now

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A Summary of the Latest Updated Medical Loss Ratio

Details: The CMS Loss Ratio methodology was developed in conjunction with a requirement from the Patient Protection and Affordable Care Act (PPACA) of 2010. As part of this legislation new rules were introduced which required medical insurance carriers to spend a minimum amount of their premiums on medical care. This minimum amount varies by

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› Url: https://www.soa.org/globalassets/assets/files/resources/research-report/2019/mimimum-mlr-analysis.pdf Go Now

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Medical Loss Ratio Guidance Portal

Details: Starting with contract year 2014, Medicare Advantage (MA) organizations, Part D prescription drug plan sponsors, and cost plans are required to submit a medical loss ratio (MLR) report to CMS on an annual basis. The purpose of this page is to share information relating to the MLR reporting process.Overview

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› Url: https://www.hhs.gov/guidance/document/medical-loss-ratio-1 Go Now

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Medical Loss Ratio (MLR) - HealthCare.gov Glossary

Details: Medical Loss Ratio (MLR) A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%.

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› Url: https://www.healthcare.gov/glossary/medical-loss-ratio-MLR/ Go Now

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CMCS Informational Bulletin - Medicaid

Details: SUBJECT: Medical Loss Ratio (MLR) Requirements Related to Third-Party Vendors . The Centers for Medicare & Medicaid Services’ (CMS) Medicaid and Children’s Health Insurance Program (CHIP) managed care final rule. 1. adopted standards for the calculation and reporting of a medical loss ratio (MLR) applicable to Medicaid and CHIP managed care

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› Url: https://www.medicaid.gov/federal-policy-guidance/downloads/cib051519.pdf Go Now

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CMCS Informational Bulletin - Medicaid

Details: SUBJECT: Medical Loss Ratio (MLR) Credibility Adjustments . The Centers for Medicare & Medicaid Services’ (CMS) Medicaid managed care final rule. 1. adopted standards for the calculation and reporting of a medical loss ratio (MLR) applicable to Medicaid and CHIP managed care contracts, including contracts with managed care

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› Url: https://www.medicaid.gov/federal-policy-guidance/downloads/cib073117.pdf Go Now

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Medical Loss Ratio - National Association of Insurance

Details: The medical loss ratio (MLR) is the share of total health care premiums spent on medical claims and efforts to improve the quality of care. [1] The remainder is the share spent on administration costs and fees, as well as profits earned. Section 2718 of the Public Health Service Act (PHS Act), as amended by the ACA, requires health insurance

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› Url: https://content.naic.org/cipr_topics/topic_medical_loss_ratio.htm Go Now

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Medical Loss Ratio (MLR) FAQs Internal Revenue Service

Details: Medical Loss Ratio (MLR) FAQs. On December 7, 2011, the Department of Health and Human Services (HHS) issued final rules on the calculation and payment of medical loss ratio (MLR) rebates to health insurance policyholders. Rebates are scheduled to begin being paid during 2012. The following questions and answers provide information on the

› Verified 6 days ago

› Url: https://www.irs.gov/newsroom/medical-loss-ratio-mlr-faqs Go Now

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CMCS Informational Bulletin - Medicaid

Details: reasonably achieve a medical loss ratio standard, as calculated under 42 CFR 438.8, of at least 85 percent for the rate year. Regardless of whether a state elects to mandate a minimum MLR, all states must ensure that managed care plans calculate and report an MLR in accordance with the requirements in 42 CFR 438.8.

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› Url: https://www.medicaid.gov/federal-policy-guidance/downloads/cib060520_new.pdf Go Now

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CMS Issues Final Rule on Medical Loss Ratio for Medicare

Details: On May 23, 2013, CMS issued its Final Rule on Medical Loss Ratio (MLR) requirements for Medicare Advantage (MA) and Medicare Part D programs. 1 MLR calculates the percentage of revenue used by MA organizations and Part D sponsors for patient care, rather than for other items such as administrative and marketing costs or profit. The higher the MLR, the more the MA organization or …

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› Url: https://www.hklaw.com/en/insights/publications/2013/06/cms-issues-final-rule-on-medical-loss-ratio-for-me Go Now

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What is the Medical Loss Ratio of the Affordable Care Act?

Details: For example, in 2019, CMS suspended UnitedHealthcare’s Medicare contract H5322 because it did not meet the medical loss ratio requirement for three years. The plan could not accept new Medicare

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› Url: https://healthpayerintelligence.com/news/what-is-the-medical-loss-ratio-of-the-affordable-care-act Go Now

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California's Medical Loss Ratio (MLR) Database, Findings, 2019

Details: Sources: Medical Loss Ratio Data and System Resources, Public Use Files (2017-2019), Centers for Medicare and Medicaid Services (CMS). California’s Medical Loss Ratio (MLR) Database, Findings, 2019 CALIFORNIA HEALTH CARE ALMANAC QUICK REFERENCE GUIDE September 2021 MLR Summary INDIVIDUAL SMALL GROUP LARGE GROUP ALL

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› Url: https://www.chcf.org/wp-content/uploads/2016/07/MedicalLossRatio2019QRG.pdf Go Now

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Health Insurer Financial Performance in 2020 KFF

Details: The medical loss ratios shown in this issue brief differ from the definition of MLR in the ACA and CMS Medicaid managed care final rule, which makes some adjustments for quality improvement and

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› Url: https://www.kff.org/private-insurance/issue-brief/health-insurer-financial-performance-in-2020/ Go Now

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Medical Loss Ratio (MLR) Rebate FAQs Cigna

Details: Medical Loss Ratio (MLR) is the percent of premiums an insurance company spends on claims and expenses that improve health care quality. The health care reform law requires insurance companies to pay annual rebates if the MLR for groups of health insurance policies issued in a state is less than 85 percent for large employer group policies and

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› Url: https://www.cigna.com/employers-brokers/insights/informed-on-reform/mlr-rebate-faqs Go Now

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Quick Take: Medicaid MCOs and Medical Loss Ratio (MLR

Details: This marks the first time CMS has ever made its approval of a state’s waiver request contingent on a minimum MLR requirement for health plans contracting with …

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› Url: https://www.kff.org/medicaid/fact-sheet/medicaid-mcos-and-medical-loss-ratio-mlr/ Go Now

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MASSACHUSETTS MEDICAL LOSS RATIOS

Details: The CMS proposed rule further encourages states to establish a “maximum” MLR, with consideration for the unique circumstances of their Medicaid programs and markets. No proposed threshold is given. 19 MASSACHUSETTS’ MEDICAL LOSS RATIOS IN CONTEXT (2013) 20 In 2013, the latest year for which complete Massachusetts market data

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› Url: https://www.chiamass.gov/assets/docs/r/pubs/15/MLR-Brief-2015.pdf Go Now

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Risk Corridors MLR Guidance Guidance Portal

Details: Treatment of Risk Corridors Recovery Payments in the Medical Loss Ratio and Rebate Calculations. Guidance for health insurance issuers clarifying how to factor recovered risk corridor payments into MLR and Rebate Calculations. Download the Guidance Document. Proposed. Issued by: Centers for Medicare & Medicaid Services (CMS)

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› Url: https://www.hhs.gov/guidance/document/risk-corridors-mlr-guidance Go Now

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MEDICAL LOSS RATIO (MLR) REPORT

Details: The data included in the MLR Reporting Tool will be used to calculate the Medicare medical loss ratio (MLR) and remittance amount, if any. These filing instructions apply to the Contract Year (CY) 2014 MLR reporting year. An attestation must be submitted in HPMS for each MLR Report.

› Verified 7 days ago

› Url: http://www.reginfo.gov/public/do/DownloadDocument?objectID=43300801 Go Now

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MEDICAL LOSS RATIO (MLR) REPORT - HHS.gov

Details: The MLR Data Form collects the Medicare medical loss ratio (MLR) and remittance amount, if any, or that the contract is non-credible. These filing instructions apply to the CY 2019 MLR reporting year. An attestation must be submitted in HPMS for each MLR Data Form.

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› Url: https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/2012302264-wl-cy2019_mlr_reporting_tool_instructions.pdf Go Now

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The 2017 Health Insurance Medical Loss Ratio and Rebates

Details: The 2017 Health Insurance Medical Loss Ratio and Rebates Results: A Brief Summary . March 5, 2019 . The Medical Loss Ratio (MLR) provision established by the Affordable Care Act (ACA) requires health insurers who fail to spend specified percentages of their premium income on medical and quality care improvement expenses to pay rebates to their customers. The goal of this provision is to …

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› Url: https://www.markfarrah.com/mfa-briefs/the-2017-health-insurance-medical-loss-ratio-and-rebates-results-a-brief-summary-by-mark-farrah-associates-/ Go Now

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Reform provisions - medical loss ratio UnitedHealthcare

Details: This provision requires insurers to report plan costs for the purpose of calculating the insurers' medical loss ratio (the percentage of insurance premium dollars spent on reimbursement for clinical services and activities to improve health care quality). Large group insurers must spend at least 85 percent of premium dollars on claims and

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› Url: https://www.uhc.com/united-for-reform/health-reform-provisions/medical-loss-ratio Go Now

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DRG Payment System: How Hospitals Get Paid

Details: To figure out how much money your hospital got paid for your hospitalization, you must multiply your DRG’s relative weight by your hospital’s base payment rate. Here’s an example with a hospital that has a base payment rate of $6,000 when your DRG’s relative weight is 1.3: $6,000 X 1.3 = $7,800. Your hospital got paid $7,800 for your

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› Url: https://www.verywellhealth.com/how-does-a-drg-determine-how-much-a-hospital-gets-paid-1738874 Go Now

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The Final 2022 Payment Notice: Exchanges, Medical Loss

Details: CMS chose not to finalize the Trump administration’s methodology for calculating the premium adjustment percentage, which will lower consumer out-of-pocket costs by $400. Medical Loss Ratios

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› Url: https://www.healthaffairs.org/do/10.1377/hblog20210501.979745/full/ Go Now

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What is the medical loss ratio? healthinsurance.org

Details: The ACA also imposes a medical loss ratio requirement of 85 percent on Medicare Advantage plans, but rebates are sent to the Centers for Medicare and Medicaid services instead of to consumers. Find affordable health plans.

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› Url: https://www.healthinsurance.org/glossary/medical-loss-ratio/ Go Now

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Medical Loss Ratio American Academy of Actuaries

Details: Medical Loss Ratio Work Group's comments to HHS on a proposed rule that requires issuers to offer a new type of individual health insurance policy covering contraceptive benefits. The comments focus only on the effect of the proposed rule on the MLR calculation. (March 28, 2013 )

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› Url: https://www.actuary.org/site-section/public-policy/health/compass-medical-loss-ratio Go Now

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New CMS guidance for Medicaid managed care medical loss

Details: The bulletin indicates CMS will conduct financial audits of Medicaid managed care plans’ MLR calculations, with a specific focus on proper reporting of subcontractor expenditures. 1 §438.8: Medical loss ratio (MLR) standards. Available at: CMS (May 15, 2019). Medical Loss Ratio (MLR) Requirements Related to Third-Party Vendors.

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› Url: https://assets.milliman.com/ektron/cms-guidance-medicare-managed-care.pdf Go Now

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UHC Medicare Plan Suspended for Failing to Meet Medical

Details: CMS announced that a UnitedHealthcare contract will be suspended for a year for failing to reach the mandatory 85 percent medical loss ratio. October 15, 2019 - …

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New Guidance Allows Premium Credits For Consumers Health

Details: On August 4, 2020, the Centers for Medicare and Medicaid Services Medical loss ratio Cite As “New Guidance Allows Premium Credits For …

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› Url: https://www.healthaffairs.org/do/10.1377/hblog20200806.126716/full/ Go Now

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Review of Pennsylvania Medicaid Managed Care Program

Details: Review of Pennsylvania Medicaid Managed Care Program Potential Savings With Minimum Medical Loss Ratio . 07-12-2017 Audit (A-03-15-00203) Complete Report Report in Brief Private health insurers, Medicare Advantage plans, and Medicare Part D sponsors are required to spend a fixed percentage of premium dollars to provide medical services and health quality improvement …

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› Url: https://oig.hhs.gov/oas/reports/region3/31500203.asp Go Now

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Medicaid Managed Care Program: Medical Loss Ratio …

Details: Medical Loss Ratio Formula Documentation 1 April 2019 Background Milliman, Inc. (Milliman) has been retained by the Rhode Island Executive Office of Health and Human Services (EOHHS) to develop a Medical Loss Ratio (MLR) reporting tool for completion of the federal MLR reporting requirements for state fiscal year (SFY) 2018.

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› Url: https://eohhs.ri.gov/sites/g/files/xkgbur226/files/Portals/0/Uploads/Documents/RIteSmiles/11_Medicaid_Managed_Care_Program_Medical_Loss_Ratio_Calculation.pdf Go Now

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Medical Loss Ratio Filing Instructions for Medicare

Details: The data included in the MLR Reporting Tool will be used to calculate the Medicare medical loss ratio (MLR) and remittance amount, if any. These filing instructions apply to the CY 2016 MLR reporting year. An attestation must be submitted in HPMS for each MLR Report.

› Verified 8 days ago

› Url: https://www.reginfo.gov/public/do/DownloadDocument?objectID=82444001 Go Now

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Healthcare Payers Face Challenges with Medical Loss Ratio

Details: By Vera Gruessner. November 11, 2016 - Under the Patient Protection and Affordable Care Act’s medical loss ratio, health payers are required to …

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